Real-world assessment of multipolar and point-by-point mapping for premature ventricular contraction ablation

Author:

Sousa Pedro A1ORCID,Tonko Johanna23ORCID,Dilling-Boer Dagmara4ORCID,Barra Sérgio5ORCID,Eberl Anna-Sophie6ORCID,Pezo Borka7ORCID,Cortez-Dias Nuno8ORCID,Khoueiry Ziad9,Medeiros Paulo10ORCID,Rodríguez-Mañero Moisés11ORCID,Lebreiro Ana12ORCID,Pereira Mariana13ORCID,Puga Luís10ORCID,Scherr Daniel6ORCID,António Natália11415ORCID,Ferreira Afonso8ORCID,Saleiro Carolina1ORCID,Lagrange Philippe9ORCID,Adão Luis12ORCID,de Sousa Joao8ORCID,Elvas Luís1,Oliveira Mário15ORCID,Gonçalves Lino114ORCID,Silberbauer John2ORCID

Affiliation:

1. Pacing & Electrophysiology Unit, Cardiology Department, Coimbra’s Hospital and University Center , Morada: Praceta Prof Mota Pinto, 3000-075 Coimbra , Portugal

2. Cardiology Department, Sussex Cardiac Centre , Brighton , UK

3. Institute of Cardiovascular Science, University College London , London , UK

4. Cardiology Department, Hartcentrum Hasselt , Hasselt , Belgium

5. Cardiology Department, Hospital da Luz Arrábida , V. N. Gaia , Portugal

6. Division of Cardiology, Department of Medicine, Medical University of Graz , Graz , Austria

7. Cardiology Department, University Hospital Centre Zagreb , Zagreb , Croatia

8. Arrhythmia Unit, Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Center , Lisbon , Portugal

9. Cardiology Department, Clinique Saint Pierre , Perpignan , France

10. Cardiology Department, Centro Hospitalar de Entre Douro e Vouga , Santa Maria da Feira , Portugal

11. Cardiology Department , University Center Hospital of Santiago, Santiago de Compostela , Spain

12. Cardiology Department, University Hospital Center of São João , Porto , Portugal

13. Biosense Webster , Portugal

14. Faculty of Medicine, ICBR, University of Coimbra , Coimbra , Portugal

15. Cardiology Department, Santa Marta Hospital , Lisboa , Portugal

Abstract

Abstract Aims We aimed to assess the acute and midterm efficacy of premature ventricular contraction (PVC) ablation guided by multielectrode and point-by-point (PbP) mapping. Methods and results This is a retrospective, international multicentre study of consecutive patients referred for PVC ablation in 10 hospital centres from January 2017 to December 2021. Based on the mapping approach, two cohorts were identified: the ‘Multipolar group’, where a dedicated high-density mapping catheter was employed, and the ‘PbP group’, where mapping was performed with the ablation catheter. Procedural endpoints, safety, and acute (procedural) and midterm efficacies were assessed. Of the 698 patients included in this study, 592 received activation mapping [46% males, median age of 55 (41–65) years]—248 patients in the Multipolar group and 344 patients in the PbP group. A higher number of activation points [432 (217–843) vs. 95 (42–185), P < 0.001], reduced mapping time (40 ± 38 vs. 61 ± 50 min, P < 0.001), and shorter procedure time (124 ± 60 vs. 143 ± 63 min, P < 0.001) were reported in the Multipolar group. Both groups had high acute success rates (84.7% with Multipolar mapping vs. 81.3% with PbP mapping, P = 0.63), as well as midterm efficacy (83.4% vs. 77.4%, P = 0.08), with no significant differences in the risk of adverse events (6.0% vs. 3.5%, P = 0.24). However, for left-sided PVC ablation specifically, there was a higher midterm efficacy in the Multipolar group (80.7% vs. 69.5%, P = 0.04), with multipolar mapping being an independent predictor of success [adjusted OR = 2.231 (95% CI, 1.476–5.108), P = 0.02]. Conclusion The acute and midterm efficacies of PVC ablation are high with both multipolar and PbP mapping, although the former allows for quicker procedures and may potentially improve the outcomes of left-sided PVC ablation.

Publisher

Oxford University Press (OUP)

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