AFACART: Noninvasive mapping in right direction

Sebastien Knecht, MD

Sebastien Knecht, MD


The utility, procedural benefits and comparative efficacy of a 252-electrode noninvasive mapping system for AF will be placed under the spotlight this afternoon, with Sebastien Knecht (Brugmann University Hospital, Brussels, Belgium) outlining key results from the ongoing AFACART trial.1

The primary objective of the trial has been to evaluate the utility of noninvasive mapping during persistent AF electrophysiology procedures, in terms of acute AF termination to atrial tachycardia or sinus rhythm. Secondary objectives are to compare the 252-electrode system directly to conventional standard-of-care methods (particularly in terms of its ability to reduce RF and procedural time), as well as evaluating the absence of recurrence of persistent AF at 12 months.

Spanning eight European centers, follow-up is expected in July of this year, but Professor Knecht is keen to summarize some of the key findings thus far at AF Symposium: “Concerning the primary endpoint, in 64% of patients we had AF termination, using only ablation of the rotor zone,” he said.

This success rate increased as more techniques were used (as per the protocol). “If there as no termination during the driver ablation, we’d go for PV isolation—complete if necessary,” explained Professor Knecht. By adding this step, results improved to 66%--and by further adding linear lesions, this improved to 73% acute termination.

“For the follow-up we now have a mean of six months, and we have already around 20 patients who have completed this follow-up (by December, 2014),” said Professor Knecht, adding: “At six months, 83% of patients are completely free from AF, and 73% of these patients are off anti-arrhythmic drugs.”

With the noninvasive technique involving a vest of 252 electrodes, Professor Knecht commented on the typical setup procedure, and any limitations. “Actually, the only problem is that the patient has to be in atrial fibrillation to record,” he said. “(It is dependent) on the maturity of the persistent AF in the patient, as always, but we can do it the day before for instance, or in the morning, or even two days before if necessary. So, it is more a question of organization.”

At this interim stage, Professor Knecht stressed that the AFACART study has served the investigators well in terms of seeing if results are reproducible using the noninvasive system, and as such he is looking to ensure future investigations are a big focus: “There are some comparisons which are ongoing, and we will probably do another randomized and prospective study in the future to compare with a more conventional approach,” he said in closing.


Tammy Griffin-Kumpey