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Ablation in Atrial Fibrillation with Ventricular Pacing Results in Similar Catheter Stability and Arrhythmia Recurrence Compared to Ablation in Sinus Rhythm with Atrial Pacing
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  • Matthew Dai,
  • Chirag Barbhaiya,
  • Anthony Aizer,
  • Douglas Holmes,
  • Scott Bernstein,
  • David Park,
  • Edward Kogan,
  • Jonathan Hyde,
  • Michael Spinelli,
  • Larry Chinitz,
  • Lior Jankelson
Matthew Dai
NYU Langone Health
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Chirag Barbhaiya
NYU Langone Health
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Anthony Aizer
New York University Medical Center
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Douglas Holmes
New York University Medical Center
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Scott Bernstein
New York University School of Medicine
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David Park
NYU Langone Medical Center
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Edward Kogan
NYU Langone Health
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Jonathan Hyde
NYU Langone Health
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Michael Spinelli
NYU Langone Health
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Larry Chinitz
New York University School of Medicine
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Lior Jankelson
NYU Langone Health
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Abstract

Background: Improved catheter stability is associated with decreased arrhythmia recurrence after atrial fibrillation (AF) ablation. Recently, atrial voltage mapping in AF was demonstrated to correlate better with scar as compared to mapping in sinus rhythm (SR). However, it is unknown whether ablation of persistent AF in sinus rhythm with atrial pacing or in atrial fibrillation with ventricular pacing results in differences in catheter stability or arrhythmia recurrence. Methods: We analyzed 53 consecutive patients undergoing first-time persistent AF ablation with pulmonary vein and posterior wall isolation: 27 were cardioverted, mapped, and ablated in sinus rhythm with atrial pacing, and 26 were mapped and ablated in AF with ventricular pacing. Ablation data was extracted from the mapping system and analyzed using custom MATLAB software to determine high-frequency (60Hz) catheter excursion as a novel metric for catheter spatial stability. Results: There was no difference in catheter stability as assessed by maximal catheter excursion, mean catheter excursion, or contact force variability between the atrial-paced and ventricular-paced patients. Ventricular-paced patients did have significantly greater mean contact forces compared to atrial-paced patients. One year arrhythmia-free survival was similar between the atrial paced and ventricular paced patients (78% vs 67%, p = 0.31). Conclusion: For patients with persistent AF, ablation in AF with ventricular pacing results in similar catheter stability and arrhythmia recurrence as compared to cardioversion and ablation in sinus rhythm with atrial pacing. Given the improved fidelity of mapping in AF, mapping and ablating during AF with ventricular pacing may be preferred.