Respiratory compensation improves the accuracy of electroanatomic mapping of the left atrium and pulmonary veins during atrial fibrillation ablation

BackgroundThe creation of accurate electroanatomic maps (EAM) of the left atrium and pulmonary veins is important for atrial fibrillation (AF) ablation to guide ablative lesions and improve the safety and efficacy of the procedure. Respiratory motion of the heart and the pulmonary veins affects the accuracy of these maps.PurposeThis study aims to assess changes in the left atrial and pulmonary venous anatomy due to respiration and to evaluate their implication for EAM acquisition.MethodsTwo separate EAM were created using the CARTO 3 mapping system in 22 consecutive patients (63% males; mean age, 63 ± 8 years) undergoing AF ablation at our center: a non-respiratory compensation (RC) map in which endocardial points were collected irrespective of respiratory phase and an RC map in which the points were collected during end expiration only. These maps were compared to pre-procedural cardiac CT/MRI images.ResultsNon-RC mapping required 3.2 ± 1.0 min versus 7.8 ± 2.1 min for the maps with RC. In comparison to the pre-procedural CT/MRI images, maps without RC significantly overestimated the dimensions of the pulmonary veins’ ostia compared to maps with RC in both long and short axes. Distances between the pulmonary veins were not significantly different when comparing non-RC to RC mapping at the left atrial roof or floor.ConclusionsRespiratory compensation at the time of EAM acquisition during AF ablation more accurately represents the true anatomical dimensions of the pulmonary vein ostia. The resulting more accurate maps may improve the safety and efficacy of atrial fibrillation ablation.