Table 1: Clinical Data of Selected Studies Using Novel Mapping Systems in Patients with Persistent AF*.
| Study | n | Type of AF | Study Design | Acute Response (AF Termination)† | Follow-up (Months) | Freedom from AT/AF | Major Periprocedural Complications‡ |
|---|---|---|---|---|---|---|---|
| ECGI[15] | 103 | 81% PersAF 19% long-lasting PersAF |
Prospective: Highest driver activity ablation and sequentially in the decreasing order of arrhythmogenic density ± linear lesions on the LA roof and MI until AF termination or linear block in sinus rhythm versus control (matched group for patients whose AF terminated, n=82): PVI + EGM-based linear lesions until AF termination | 80% | 12 | 64% overall 85% patients with AF termination were AF free versus 87% control population (p=ns) |
Not reported |
| FIRM[29] | 92 | 28% PxAF 72% PersAF |
RCT: FIRM ± PVI ± LA roof line versus PVI ± LA roof line |
56% versus 9% (p<0.001) |
9 | 82.4% versus 44.9% (p<0.001) | Three cardiac tamponades (one versus two), four vascular complications (one versus three), PV stenosis (one in group 2) |
| Electrogram similarity/phase-mapping combined technique[30] | 68 | 68% PersAF 32% long-lasting PersAF |
Prospective: PVI + SI and phase mapping versus PVI + CFAE |
68% versus 27% (p=0.001) |
18 ± 8 | 82.4% versus 58.8% (AF only, p=0.03) | One cardiac tamponade in PVI + CFAE arm |
| Spectral analysis and DF mapping[62] | 232 | 49.5% PxAF 50.5% PersAF |
RCT: PVI alone versus PVI + high-frequency source ablation (for patients with PersAF) | 26% versus 46% (p=ns) |
12 | 63% versus 67% (p=ns) |
Two cardiac tamponade and one vascular complication in high-frequency arm |
| CARTOFINDER[55] | 13 | 100% long-standing PsAF | Prospective: PVI + Rotor ablation | 15% | 12 | 70% | One decompensated heart failure |
| Spatiotemporal dispersion[64] | 152 | 22% PxAF 78% PersAF |
Prospective: Ablation of spatio-temporal dispersion of EGMs in AF versus PVI ± CFAE and linear ablation (step-wise approach) | 95% versus 62% (p<0.01) |
18 | 55% versus 36% (p=0.026) |
None |
| RRa[66] | 81 | 100% PersAF | RCT: PVI + RRa ablation versus PVI alone | 61% versus 30%; (p<0.007) |
12 | 73.2% versus 50% (p=0.03) |
Two femoral pseudoaneurysm (one per group) |
| RADAR system[70] | 64 | 83% PersAF 17% long-standing PersAF |
Single-arm prospective trial: PVI + drivers identified by RADAR system | 55% | 12.6 ± 0.8 | 66% | None |
| Charge/dipole density[75] | 127 | 100% PersAF | Prospective: PVI + charge density identified targets | 98% in total (32% without cardioversion) | 12 | 72.5% | Two cardiac tamponades, one stroke, one air embolism, one femoral arteriovenous fistula and one femoral lymphocele. |
| Electrographic flow mapping[77] | 25 | 96% PersAF 4% long-standing PersAF |
Prospective: Step 1: PVI + FIRM Step 2: EGMs re-analysis using electrographic flow mapping after the procedure to identify active AF sources and discriminate from passive rotational phenomena |
NA | NA | NA | None |
| iAM/iFM mapping algorithm[63] | Animal and human study: Step 1: test of the single-signal algorithms to detect rotational-footprints in optical movies from five ex vivo Langendorff-perfused PersAF sheep hearts and in computer simulations Step 2: in vivo high-density electroanatomical atrial mapping in 16 pigs with PersAF to perform leading driver and rotational footprint maps to guide ablation Step 3: iAM/iFM-guided mapping and ablation in three patients with PersAF despite ≥1 previous PVI procedures |
Step 2: 92.3% Step 3: 33% |
16 (step 3) | Two out of three patients (one patient displayed too large leading areas to be safely targeted by catheter-based ablation) | None (step 3) |
*The studies were selected based on the following criteria: RCT or prospective series with more specific targets on the study design, large sample numbers, and a follow-up of at least 12 months when available. †AF termination rate may show limitations to predict freedom from AF in the long-term follow-up.[56] ‡Major complications were defined as those that were likely to result in permanent injury, prolongation of hospitalisation, requirement of intervention for treatment, or death. AT = atrial tachycardia; BSM = body surface mapping; CFAE = complex fractionated atrial electrogram; CL = cycle length; DF = dominant frequency; ECGI = electrocardiographic imaging; EGMs = electrograms; FIRM = focal impulse and rotor modulation; iAM/iFM = instantaneous amplitude modulation/instantaneous frequency modulation; LA = left atrium; MI = mitral isthmus; n = number; NA = not applicable; ns = not significant; PersAF = persistent AF; PxAF = paroxysmal AF; PV = pulmonary vein; PVI = pulmonary vein isolation; RA = right atrium; RRa = repetitive-regular activities; RCT = randomised clinical trial; SI = similarity index.