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Does Merged three-dimensional mapping Improve Contact foRce and long-term procedure Outcome in Atrial Fibrillation ablation? (MICRO-AF study): A prospective randomized controlled study
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  • Dong Geum Shin,
  • Seung-Young Roh,
  • Jinhee Ahn,
  • Sang-Weon Park,
  • Dong-Hyeok Kim,
  • Sang-Jin Han,
  • Hong Euy Lim
Dong Geum Shin
Hallym University Medical Center
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Seung-Young Roh
Korea University Guro Hospital
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Jinhee Ahn
Pusan National University Hospital
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Sang-Weon Park
Sejong General Hospital
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Dong-Hyeok Kim
Ewha Womans University
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Sang-Jin Han
Hallym University Sacred Heart Hospital
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Hong Euy Lim
Hallym University Sacred Heart Hospital

Corresponding Author:[email protected]

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Introduction: Integration of electroanatomical map (EAM) with preacquired three-dimensional (3D) cardiac images provides detailed appreciation of the complex anatomy of the left atrium (LA) and pulmonary vein (PV). High-density (HD) multi-electrode mapping catheters have enabled creating more accurate EAM reflecting real-time volume-rendered LA-PV geometry during atrial fibrillation (AF) ablation. However, no study has compared the outcomes of AF ablation using HD-EAM versus 3D-merged map. We aimed to investigate the procedural and clinical outcomes of AF ablation with HD-EAM (HD-EAM group) versus 3D-merged map (Merge group). Methods: One hundred patients (59.5±11.5years, 53% with paroxysmal AF [PAF]) were randomly assigned (1:1) to HD-EAM or Merged group. HD multi-electrode mapping and contact force (CF)-sensing catheters were used to create virtual LA-PV chamber and to perform wide antral circumferential ablation (WACA), respectively. Results: The two groups showed no significant differences in baseline characteristics and procedural data including ablation time, fluoroscopy time, LA voltage, and CF. PV isolation with a single WACA line was achieved in 21 (42%) and 27 (54%) patients in the Merge and HD-EAM groups, respectively (P=NS). CF was significantly lower in lesions with gap than lesions without gap after a single WACA (7.3±7.3 g vs. 16.0±8.3, respectively, P<0.001). During the 12-month follow-up, no significant difference in AF recurrence was observed between two groups, irrespective of AF type. In multivariate analysis, non-PAF was an independent risk factor for AF recurrence. Conclusion: Integration of 3D cardiac imaging did not improve procedural and clinical outcomes. HD-EAM provides an accurate real-time LA geometry.