Prospective STAR Guided Ablation in Persistent AF using Sequential Mapping with Multipolar Catheters.

Background - A novel 'STAR' mapping approach to guide AF ablation using basket catheters recently showed high rates of AF termination and subsequent freedom from AF. Methods - This study aimed to determine whether STAR mapping using sequential recordings from conventional pulmonary vein mapping catheters could achieve similar results. Patients with persistent AF <2 years were included. Following pulmonary vein isolation (PVI) AF drivers (AFDs) were identified on sequential STAR maps created with PentaRay, IntellaMap Orion, or Advisor HD Grid catheters. Patients had a minimum of 10 multipolar recordings of 30-seconds each. These were processed in real-time and AFDs were targeted with ablation. An ablation response was defined as AF termination or CL slowing ≥30ms. Results - Thirty patients were included (62.4±7.8 years old, AF duration 14.1±4.3 months) of which 3 had AF terminated on PVI, leaving 27 patients that underwent STAR-guided AFD ablation. Eighty-three potential AFDs were identified (3.1±1.0 per patient) of which 70 were targeted with ablation (2.6±1.0 per patient). An ablation response was seen at 54 AFD (77.1% of AFD; 21 AF termination and 33 CL slowing) and occurred in all 27 patients. No complications occurred. At 17.3±10.1 months, 22/27 (81.5%) patients undergoing STAR guided ablation were free from AF/AT off anti-arrhythmic drugs. Conclusions - STAR-guided AFD ablation through sequential mapping with a multipolar catheter effectively achieved an ablation response in all patients. AF terminated in a majority of patients, with a high freedom from AF/AT off anti-arrhythmic drugs at long-term follow-up.