Comparison of characteristics and acute ablation outcome of atrial fibrillation drivers detected using octaray vs. pentaray catheter

Abstract Background Atrial fibrillation (AF) driver ablation is proposed as treatment strategy beyond pulmonary vein (PV) isolation in persistent AF patients. The CARTOFINDER mapping system (Biosense Webster Inc.) can depict two types of activation patterns, focal and rotational activation, using unipolar potentials during AF. Recently, an 8-spline 48-electrodes mapping catheter (OctaRay) was developed. Purpose To evaluate the characteristics of AF drivers detected by CARTOFINDER using the OctaRay catheter and the acute termination compared to previous mapping catheter (PentaRay). Methods This is a multicenter prospective observational study from 6 hospitals where 47 persistent AF patients underwent initial catheter ablation from April to December 2023. We assessed the frequency and distribution of AF drivers in both atrium identified by CARTOFINDER using the OctaRay catheter before procedure. After PV isolation, additional ablation was performed on high-repetitive activations (focal activation>22 repetitions, rotational activation>17 repetitions) and the rate of acute AF termination was evaluated. Acute AF termination was defined as transition to sinus rhythm or atrial tachycardia (AT). The results were compared to 29 patients in whom the PentaRay catheter was used from September 2022 to March 2023. Results The mean age of OctaRay group was 72.0±8.6 years. The median AF duration was 0.7 years, and the prevalence of long-standing AF was 26%. All clinical characteristics was not significantly different between OctaRay and PentaRay group. Focal activation was more frequently identified in OctaRay group than in PentaRay group (94.1points/patient vs. 36.3points/patient, P