Universität zu Köln

Willems, Stephan, Verma, Atul ORCID: 0000-0002-1020-9727, Betts, Timothy R., Murray, Steven, Neuzil, Petr, Ince, Hueseyin, Steven, Daniel, Sultan, Arian, Heck, Patrick M., Hall, Mark C., Tondo, Claudio, Pison, Laurent, Wong, Tom, Boersma, Lucas V., Meyer, Christian and Grace, Andrew (2019). Targeting Nonpulmonary Vein Sources in Persistent Atrial Fibrillation Identified by Noncontact Charge Density Mapping UNCOVER AF Trial. Circ.-Arrhythmia Electrophysiol., 12 (7). PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1941-3084

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Abstract

Background Identification and elimination of nonpulmonary vein targets may improve clinical outcomes in patients with persistent atrial fibrillation (AF). We report on the use of a novel, noncontact imaging and mapping system that uses ultrasound to reconstruct atrial chamber anatomy and measures timing and density of dipolar, ionic activation (ie, charge density) across the myocardium to guide ablation of atrial arrhythmias. Methods The prospective, nonrandomized UNCOVER AF trial (Utilizing Novel Dipole Density Capabilities to Objectively Visualize the Etiology of Rhythms in Atrial Fibrillation) was conducted at 13 centers across Europe and Canada. Patients with persistent AF (>7 days, <1 year) aged 18 to 80 years, scheduled for de novo catheter ablation, were eligible. Before pulmonary vein isolation, AF was mapped and then iteratively remapped to guide each subsequent ablation of charge density-identified targets. AF recurrence was evaluated at 3, 6, 9, and 12 months using continuous 24-hour ECG monitors. The primary effectiveness outcome was freedom from AF >30 seconds at 12 months for a single procedure with a secondary outcome being acute procedural efficacy. The primary safety outcome was freedom from device/procedure-related major adverse events. Results Between October 2016 and April 2017, 129 patients were enrolled, and 127 underwent mapping and catheter ablation. Acute procedural efficacy was demonstrated in 125 patients (98%). At 12 months, single procedure freedom from AF on or off antiarrhythmic drugs was 72.5% (95% CI, 63.9%-80.3%). After 1 or 2 procedures, freedom from AF was 93.2% (95% CI, 87.1%-97.0%). A total of 29 (23%) retreatments because of arrhythmia recurrence were performed with average time from index procedure to first retreatment being 7 months. The primary safety outcome was 98% with no device-related major adverse events reported. Conclusions This novel ultrasound imaging and charge density mapping system safely guided ablation of nonpulmonary vein targets in persistent AF patients with 73% single procedure and 93% second procedure freedom from AF at 12 months.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Willems, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Verma, Atul UNSPECIFIED orcid.org/0000-0002-1020-9727 UNSPECIFIED Betts, Timothy R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Murray, Steven UNSPECIFIED UNSPECIFIED UNSPECIFIED Neuzil, Petr UNSPECIFIED UNSPECIFIED UNSPECIFIED Ince, Hueseyin UNSPECIFIED UNSPECIFIED UNSPECIFIED Steven, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Sultan, Arian UNSPECIFIED UNSPECIFIED UNSPECIFIED Heck, Patrick M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hall, Mark C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Tondo, Claudio UNSPECIFIED UNSPECIFIED UNSPECIFIED Pison, Laurent UNSPECIFIED UNSPECIFIED UNSPECIFIED Wong, Tom UNSPECIFIED UNSPECIFIED UNSPECIFIED Boersma, Lucas V. UNSPECIFIED UNSPECIFIED UNSPECIFIED Meyer, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Grace, Andrew UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-136009
DOI:	10.1161/CIRCEP.119.007233
Journal or Publication Title:	Circ.-Arrhythmia Electrophysiol.
Volume:	12
Number:	7
Date:	2019
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1941-3084
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CATHETER ABLATION; CRYOBALLOON Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/13600