Impact of 3D mapping on procedural characteristics and outcomes in cryoballoon pulmonary vein isolation for atrial fibrillation.

Purpose: The use of 3D mapping during cryoballoon pulmonary vein isolation (PVI) is optional with added cost but potential benefit in aiding vein identification, reducing fluoroscopy, and post-ablation testing. Data are limited evaluating procedural characteristics and outcomes in patients undergoing cryoballoon PVI with mapping vs. no mapping. In the present study, we compare procedural characteristics and recurrence-free rates in patients undergoing cryoballoon PVI among patients using CARTO®, NavX™, or no mapping system.

Methods: We evaluated a single center registry of patients undergoing cryoballoon PVI from 2013 to 2016, retrospectively. Patients undergoing a redo procedure or additional RF ablation were excluded. Baseline and procedural characteristics were compared among CARTO, NavX, and no mapping groups. Post-PVI patients were assessed for atrial arrhythmia recurrence after a 3-month blanking period. Recurrence was based on typical symptoms or ECG/event monitor evidence of atrial fibrillation (AF). Kaplan-Meier analysis was used to compare arrhythmia-free survival between groups.

Results: We included 432 patient procedures, 98 using mapping systems (45 NavX, 53 CARTO), and 334 without. When using the CARTO mapping system compared to NavX or no mapping, there were longer procedure times (168 vs.109 vs.115 min, p < 0.001) and LA dwell times (110 vs.81 vs.87 min, p < 0.001). Additionally, both CARTO and NavX, when compared to no mapping, had longer fluoroscopy times (32 vs.31 vs.26 min, p < 0.001). Overall, total ablation time was increased for patients without mapping systems compared to NavX. There were no significant differences in 1-year recurrence-free rates between CARTO, NavX, and no mapping groups (64.9 vs. 65.0 vs. 64.6%, p = 0.278).

Conclusion: Use of CARTO is associated with increased procedure and LA dwell times compared to NavX or no mapping. Mapping system use yielded longer fluoroscopy times without an improvement in atrial fibrillation recurrence. Given the additional cost of mapping, the role for routine use in cryoballoon PVI is unclear.