Utilizing the novel AI-guided STAR Apollo™ Mapping System in complex redo-ablations: a case report of successful catheter ablation in a patient with persistent left superior vena cava

Abstract

Background Persistent left superior vena cava (PLSVC) can both initiate and perpetuate atrial fibrillation (AF) and poses several challenges to catheter ablation procedures. Novel mapping technologies offer promising potential to these complex patients. We present the first recorded case of artificial intelligence guided pulsed field ablation (PFA) in persistent AF with PLSVC. Case summary A 70-year-old patient with PLSVC and persistent AF underwent a third-repeat catheter ablation. A three-dimensional geometry of the atria was generated, and STAR Apollo Mapping was used to identify target substrates [early sites of activation (ESAs) and repetitive pattern of activation STARbursts] in real time. Two ESAs were identified in the left atrium (LA) and three in the right atrium; all of these were targeted. Ablation in the PLSVC that overlaid an LA septal ESA terminated AF to sinus rhythm. Remapping confirmed pulmonary vein isolation and exit block, and no further arrhythmias were inducible. There were no procedural complications; the patient was discharged the same day. Discussion STAR mapping aided identification of alternative ablation targets that would be challenging to identify using classical electro-anatomical mapping alone. This case demonstrates a novel use of this technology in improving procedural outcomes for complex AF patients.