Effect of 3D electroanatomical mapping on long-term outcomes following cryoballoon ablation for atrial fibrillation
A E Karanikola, D Tsiachris, C K Antoniou, M Botis, P Alexandrou, K Pamporis, N Argyriou, A Kordalis, K TsioufisAbstract
Introduction
Cryoballoon ablation (CBA) is an established and effective thermal energy source for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). However, the role of three-dimensional electroanatomical mapping (3D-EAM) during CBA remains unclear. It is hypothesized that the use of 3D-EAM could enhance procedural accuracy and efficiency, thereby improving patient outcomes.
Purpose
This study aimed to evaluate the impact of 3D-EAM on long-term arrhythmia recurrence following cryoballoon ablation.
Methods
In this retrospective, single-center study, consecutive patients undergoing first-time PVI-based catheter ablation for paroxysmal or persistent AF between January 2017 and January 2023 were included. Patients were divided into two groups. In the first group, a multipolar mapping catheter was used to reconstruct left atrial anatomy prior to PVI with the 4th generation cryoballoon and to confirm isolation after the procedure (EAM group), while in the second group, CBA was performed under fluoroscopy guidance alone (no-EAM group). The primary endpoint was atrial arrhythmia recurrence during long-term follow-up. Arrhythmia-free survival was compared by Kaplan-Meier analysis, and predictors of recurrence were assessed by Cox regression.
Results
A total of 148 patients were included: 47 in the EAM group (mean age 62±11 years; 33% female; 40% paroxysmal AF; LA diameter 43.0±5.4 mm; LVEF 55.3±8.5%; AF duration 3.6±4.3 years) and 101 in the no-EAM group (mean age 59±14 years; 26% female; 61% paroxysmal AF; LA diameter 43.5±5.3 mm; LVEF 56.7±5.8%; AF duration 5.1±5.5 years). Over a median follow-up of 4.4 years (IQR 3.8–5.2), 44% of patients experienced arrhythmia recurrence, with more than two-thirds of recurrences occurring after the first year. Very late recurrence (≥12 months) occurred more frequently among patients in the 3D-EAM group(89.5%) compared with the no-EAM group(63.0%) (χ² = 4.54, p = 0.03), with no difference in PV reconnection rates in those who underwent redo ablation (p=0.30). Kaplan-Meier analysis showed no significant difference in arrhythmia-free survival between the groups (log-rank p=0.97). Multivariate Cox regression identified no significant predictors of recurrence, including age, sex, LA diameter, AF type and duration, or use of 3D-EAM (HR 0.63; 95% CI 0.29–1.37; p=0.245).
Conclusions
Use of 3D electroanatomical mapping during first-time PVI with cryoballoon ablation was not associated with improved long-term rhythm outcomes. In the absence of a clear clinical benefit and given the additional procedural time and cost, routine use of 3D-EAM in cryoballoon procedures may not be justified. Further studies are warranted to identify specific patient subgroups that could benefit from EAM use.