Comparison of circumferential pulmonary vein anatomy mapping guided by 3D mapping versus a mesh mapping catheter

Abstract

Objective: Catheter-based pulmonary vein isolation (PVI) is an established therapy for paroxysmal atrial fibrillation. The high-density mesh mapper (HDMM) guides circumferential PV-atrium isolation without the 3D electroanatomic mapping. This study aims to compare circumferential pulmonary vein (CPV) anatomy mapping between guiding by a 3D mapping system and the HDMM. Methods: Forty-four consecutive patients with paroxysmal atrial fibrillation were scheduled for a first procedure for PVI. A CPV ostial anatomy map guided by HDMM was set up in the CARTO system while the operator was blinded to the CARTO screen. Then CARTO-guided ipsilateral PV maps were obtained and PVI was performed. This established another set of CPV ostial anatomy maps. The differences between the two mapping images were compared and analyzed. Results: All 176 PVs in 44 patients could be mapped by both HDMM and CARTO. About 44.9% of the PV ostial anatomies were generally similar between the two different map images. The average point-to-point straight distance between the HDMM-guided map and the CARTO-guided map was 6.2 ± 1.4 mm. The area of the circumferential right PV (CRPV) in the HDMM map was larger than that in the CARTO map (P = 0.013). After a mean follow-up of 18.3 ± 4.3 months (6–24 months), 72.7% of patients (32/44) were free of atrial arrhythmia without anti-arrhythmic drugs (AADs). Conclusion: Compared to the CARTO-guided CPV anatomy image, a highly similar figure could be achieved by mapping guided by the HDMM. (Clinical trial.gov number, ChiCTR-TNRC-11001390.) Keywords: High-density mesh mapper (HDMM), Atrial fibrillation, Ablation, CARTO