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Pacing Clin Electrophysiol. 2019 Feb;42(2):216-223. doi: 10.1111/pace.13573. Epub 2018 Dec 27.

Comparison of phase mapping and electrogram-based driver mapping for catheter ablation in atrial fibrillation.

Author information

1
Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei City, Taiwan.
2
Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan.
3
Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, I-LAN, Taiwan.
4
Department of Medicine, Stanford University, Palo Alto, California.
5
Department of Biomedical Sciences and Engineering, Institute of Translational and Interdisciplinary Medicine, National Central University, Chungli, Taiwan.
6
Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei City, Taiwan.

Abstract

INTRODUCTION:

Adjunctive driver-guided ablation in addition to pulmonary vein isolation has been proposed as a strategy to improve procedural success and outcomes for various populations with atrial fibrillation (AF). First, this study aimed to evaluate the different mapping techniques for driver/rotor identification and second to evaluate the benefits of driver/rotor-guided ablation in patients with paroxysmal and persistent AF (PerAF).

METHODS:

We searched the electronic database in PubMed using the keywords "atrial fibrillation," "rotor," "rotational driver," "atrial fibrillation source," and "drivers" for both randomized controlled trials and observational controlled trials. Clinical studies reporting efficacy or safety outcomes of driver-guided ablation for paroxysmal AF or (PerAF) were identified. We performed subgroup analyses comparing different driver mapping methods in patients with PerAF. The odds ratios (ORs) with random effects were analyzed.

RESULTS:

Out of 175 published articles, seven met the inclusion criteria, of which two were randomized controlled trials, one was quasiexperimental study, and four observational studies (three case-controlled studies and one cross-sectional study). Overall, adjunctive driver-guided ablation was associated with higher rates of acute AF termination (OR: 4.62, 95% confidence interval [CI]: 2.12-10.08; P < 0.001), lower recurrence of any atrial arrhythmia (OR: 0.44, 95% CI: 0.30-0.065; P < 0.001), and comparable complication incidence.

CONCLUSIONS:

Adjunctive driver-guided catheter ablation suggested an increased freedom from AF/AT relative to conventional strategies, irrespective of the mapping techniques. Furthermore, phase mapping appears to be superior to electrogram-based driver mapping in PerAF ablation.

KEYWORDS:

atrial fibrillation; catheter ablation; driver; meta-analysis; phase-mapping

PMID:
30536679
DOI:
10.1111/pace.13573

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