Abstract 16285: Routine Use of 3D Mapping and Irrigated Ablation Improves Outcomes of Pulmonary Vein Antral Isolation Among Patients With Persistent AF

Bckground: Pulmonary Vein Antrum Isolation (PVAI) is a widely accepted treatment option in Atrial Fibrillation (AF). However, despite procedural advancements, post-PVAI AF recurrences remain a common challenge. We thought to investigate whether the addition of routine 3D electroanatomical mapping and routine use of irrigated ablation catheters (IC) vs 8 mm tip catheters made an impact on the outcomes of PVAI guided by intracardiac echocardiography (ICE) and a decapolar circular mapping catheter (CMC) alone. Methods: Patient and procedural data were collected for 884 AF consecutive patients undergoing PVI at a single Canadian center during 2004 - 2014 (469 patients in 2004-2009, Group 1vs. 415 patients in 2010-2014, Group 2). Group 1 patients received PVAI guided by ICE and CMC. All Group 2 patients had PVAI guided by ICE, CMC and 3D mapping with the use of irrigated tip ablation catheters. Mean ages for Groups 1 and 2 were = 58.6 ± 10.0 and 61.0 ± 10.7 years respectively (p= 0.001). Mean follow up time was 17.1 ± 18.8 months for Group 1 and 14.1± 9.7 months for Group 2 (p=0.003). ECG and ambulatory monitoring was performed at 1, 3, 6, and 12 months. Recurrences ≤ 3 months post-PVI were considered Early (ER), while recurrences after 3 months post-PVI were considered Late (LR). Using survival analysis, rates of LR stratified by AF type [Paroxysmal AF (PAF) vs. Non-PAF (NPAF)] were compared between the two cohorts Results: ER rate was lower in Group 2 vs. Group 1 (36.8% vs. 44.7%, P=0.05) in patients with PAF and for those with NPAF (54.8% vs. 66.9%, P=0.03). LR rates did not differ between the Groups among PAF patients (62.5% in Group 1 vs. 57.3% in Group 2, P=0.16), but improved significantly for the NPAF patients (55.6% in Group 1 vs. 37.9% in Group 2 , P=0.002). Conclusion: Late recurrence of AF post-PVI has dramatically improved since 2010 for patients with persistent AF following routine addition of 3D mapping to ICE and CMC, while substituting an irrigated for an 8mm ablation catheter.