Optimizing Ablation Sites for Pulmonary Vein Isolation Reconnections: A Novel Approach Using an Emphasis Map Combined with the Peak Frequency and Local Activation Timing Map

Shuhei Okajima; Yuhi Fujimoto; Masato Hachisuka; Hiroshige Murata; Yoshiyasu Aizawa; Kenji Yodogawa; Kuniya Asai; Wataru Shimizu; Yu-Ki Iwasaki

doi:10.1016/j.hrthm.2024.11.036

Optimizing Ablation Sites for Pulmonary Vein Isolation Reconnections: A Novel Approach Using an Emphasis Map Combined with the Peak Frequency and Local Activation Timing Map

Heart Rhythm. 2024 Nov 22:S1547-5271(24)03619-1. doi: 10.1016/j.hrthm.2024.11.036. Online ahead of print.

Authors

Shuhei Okajima¹, Yuhi Fujimoto², Masato Hachisuka¹, Hiroshige Murata¹, Yoshiyasu Aizawa¹, Kenji Yodogawa¹, Kuniya Asai¹, Wataru Shimizu¹, Yu-Ki Iwasaki¹

Affiliations

¹ Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
² Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan. Electronic address: y-fujimoto6081@nms.ac.jp.

PMID: 39581432
DOI: 10.1016/j.hrthm.2024.11.036

Abstract

Background: Although catheter ablation techniques for atrial fibrillation (AF) have advanced, a certain number of cases of reconnections after pulmonary vein (PV) isolation still exist. The diversity of the anatomical wall thickness and fiber orientation around the PVs might contribute to reconnections.

Objective: We investigated the utility of using the emphasis map's emphasize settings to determine the optimal ablation sites.

Methods: Patients undergoing AF ablation with the EnSite X system who had PV reconnections were included. The emphasis map (a combination of peak frequency and local activation timing [LAT] maps) was created to obtain the emphasize settings for indicating the optimal ablation site (Emphasis group). In another group the ablation site was determined based on LAT mapping (LAT group).

Results: A total of 64 patients (69 ± 9 years, 50 males) and 109 PVs were found to be reconnected and analyzed. Gaps were observed at 55 and 68 points of the PV isolation in the Emphasis and LAT groups, respectively. The number of ablation points needed to successfully eliminate the gaps and the total energy were markedly smaller (1.6 ± 1.1 vs. 6.3 ± 3.7, P < 0.001, and 3541 ± 2060 vs. 5606 ± 3728 joule, P = 0.001) in the Emphasis group than in the LAT group, respectively. The average optimal emphasize setting was 338 ± 67 Hz in the Emphasis group.

Conclusion: Adjusting the emphasize settings visualized the optimal ablation site, and the number of ablation points needed to re-isolate the PV might be markedly reduced.

Keywords: activation map; atrial fibrillation; catheter ablation; emphasis map; emphasize setting; peak frequency map; pulmonary vein isolation.