Background: Validation of pulmonary vein (PV) isolation (PVI) using only the Achieve catheter following cryoballoon ablation (CBA) is imperfect since pulmonary vein potentials (PVP) can be recorded in only 50–85% of the veins and residual PVP are found in up to 4.3–7.6% of the veins in remapping studies.
Aims: To study whether addition of electroanatomical mapping to Achieve catheter-guided CBA: (1) is superior for PVI and (2) correctly identifies low voltage areas (LVAs).
Methods: A total of 100 patients were randomized between Achieve catheter-guided CBA (Control group, N=50) and Achieve catheter-guided CBA with additional EnSite voltage maps performed pre- and post-CBA (Achieve Plus group, N=50). Confirmation of PVI and LVAs was done by circular mapping catheter (CMC) and EnSite mapping by a second blinded operator.
Results: Despite apparent PVI in all PVs after CBA, incomplete PVI was present in 0 out of 50 patients (0%) and 0 out of 204 PVs in the Achieve Plus group versus 6 patients out of 50 (12%; p=0.012) and 6 out of 203 PVs (3%; p=0.013) in the Control group. All 6 non-isolated PVs could be successfully isolated by additional cryo-applications. Procedure time was longer in the Achieve Plus group (75.76 ± 21.65 min vs 66.06 ± 16.83 min; p=0.014) with equal fluoroscopy times (14.85 ± 6.41 min vs 14.33 ± 8.55; p=0.732). All LVAs identified by Achieve/EnSite mapping in 14 patients were confirmed by CMC/EnSite voltage maps.
Conclusion: The addition of electroanatomical EnSite mapping to the Achieve catheter improves the PVI rate of CBA, correctly identifies LVAs and could be considered for future use.