Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO02 - Poster Session II (ID 47) Poster

D-PO02-191 - Novel Map Merge Software Markedly Reduces Procedure Time For Redo Pulmonary Vein Isolation (ID 248)

  G. Monir: Honoraria/Speaking/Consulting Fee - Medtronic; Biosense Webster, Inc..


Background: Identifying the location of conduction gaps (CGs) during redo pulmonary vein isolation (PVI) represents a challenge due to the uncertainty of the exact location of previously performed wide circumferential ablation (WACA) lines.
Objective: Evaluate the efficacy of utilizing novel software (Map Merge, CARTO® 3 System, Biosense Webster, CA, USA) in reducing procedure and radiofrequency ablation (RFA) time in redo PVI. Map Merge software allows incorporation of a previously acquired map and RFA lesion set for use in the current active map.
Methods: Sixty-two patients (Pts) presenting for redo PVI for recurrent atrial fibrillation were studied. Group (GR)1 included 32 Pts who had prior maps available and were used for Map Merge. Group 2 included 30 Pts without available prior maps. Both groups underwent CARTO® 3 System 3D mapping of the left atrium and pulmonary veins (PV) to create the anatomical structure shell. The Pts in GR1 utilized the map merge software. The shell and RFA tags from the first PVI procedure were imported and merged with the current active map. Only the first procedure RFA points were kept active for use in the second procedure shell. Activation maps were performed to localize CGs’ exit sites during pacing from PV and mapping just outside the WACA lines. Focal RFA was delivered only to target the CGs on the WACA lines to achieve PVI in group 1. In group 2, standard methods for CG localization guiding RFA to achieve PVI were performed. In both groups the procedure time including mapping and RFA time to achieve PVI/PV pair (PVP) was measured and compared.
Results: In all patients, PVI was achieved. In group 1, PVI was achieved by delivering focal RFA only on the WACA lines indicating accurate location of the imported WACA lines. Group 1 demonstrated a significant 80% reduction in the procedure time to achieve PVI/PVP from 26.6 +19.3 minutes in GR2 to 5.1+3.2 minutes in group 1 (p<0.001). The time interval between the first and the redo PVI procedures was 2-29 (11+8.8) months and 2-41 (14+11) months for the GR 1 and 2 respectively (p=0.507).
Conclusion: The novel Map Merge software used for Redo PVI allowed accurate localization of conduction gaps and significantly reduced mapping and RFA procedure time to achieve PVI.