Introduction: Catheter ablation of atrial fibrillation (AF) and/or atrial tachycardia (AT) in heart failure (HF) patients provides improvement in symptoms cardiac function and survival. However, these procedures remain challenging with higher recurrence and complication rates compared to patients with normal cardiac function. We aimed to compare outcomes of AF/AT ablations guided by an ultra-high density mapping system between HF patients and controls. Methods and results: Primary endpoint was the one-year recurrence rate of AF/AT. We retrospectively examined all Rhythmia™-guided procedures performed in Caen and Toulouse University Hospitals between 2015 and 2018 for AF/AT. Patients with reduced left ventricular ejection fraction (LVEF) (i.e. <50%), or with preserved LVEF and signs/symptoms of HF were constituted the HF group and were subsequently classified in two subgroups of HF patients with preserved (HFpEF) or reduced/mildly reduced (HFrEF) LVEF. 246 patients were included, 135 in the HF group. At one-year, 71 patients had experienced AF/AT recurrences, with no difference between HF group versus non-HF group (31.9 vs 25.2% respectively, p=0.262). AF/AT recurrence rates were not different between HFpEF and HFrEF subgroups (37.1 vs 26.4% respectively, p=0.196). In multivariate analysis, patients with mitral regurgitation (p=0.011), hypertrophic cardiomyopathy (p=0.011) and persistent AF (p=0.02) were at higher risk of recurrence. AF/AT recurrence was not significantly associated with HF hospitalization (p=0.078) but HF status was the only independent predictive factor of HF hospitalization (p=0.002). Patients in the HF group showed significant improvement in both their NYHA class and LVEF than non-HF patients. After ablation procedures, while patients with HFrEF and HFpEF showed similar NYHA class improvement, LVEF only improved in HFrEF patients. The rate of complications were comparable in both groups. Conclusion: Clinical outcomes of AF/AT ablations guided by UHD mapping system appear similar in HF and non-HF patients. During the follow-up period, patients with HF exhibit improvement of NYHA status and LVEF.

We report the case of a reciprocating tachycardia using a purely retrograde decremental slow-conducting accessory pathway. High density 3D mapping of the atrial insertion reveals a large area of specific potentials at the level of the tricuspid annulus, which can be regarded as an accessory conduction network

Introduction: Ultra-high-density mapping for ventricular tachycardia (VT) is increasingly used. However, manual annotation of local abnormal ventricular activities (LAVAs) is challenging in this setting. Therefore, we assessed the accuracy of the automatic annotation of LAVAs with the Lumipoint algorithm of the Rhythmia system (Boston Scientific). Methods and Results: One hundred consecutive patients undergoing catheter ablation of scar-related VT were studied. Areas with LAVAs and ablation sites were manually annotated during the procedure and compared with automatically annotated areas using the Lumipoint features for detecting late potentials (LP), fragmented potentials (FP), and double potentials (DP). The accuracy of each automatic annotation feature was assessed by re-evaluating local potentials within automatically annotated areas. Automatically annotated areas matched with manually annotated areas in 64 cases (64%), identified an area with LAVAs missed during manual annotation in 15 cases (15%), and did not highlight areas identified with manual annotation in 18 cases (18%). Automatic FP annotation accurately detected LAVAs regardless of the cardiac rhythm or scar location; automatic LP annotation accurately detected LAVAs in sinus rhythm, but was affected by the scar location during ventricular pacing; automatic DP annotation was not affected by the mapping rhythm, but its accuracy was suboptimal when the scar was located on the right ventricle or epicardium. Conclusion: The Lumipoint algorithm was as/more accurate than manual annotation in 79% of patients. FP annotation detected LAVAs most accurately regardless of mapping rhythm and scar location. The accuracy of LP and DP annotations varied depending on mapping rhythm or scar location.