Background: Recent mapping studies demonstrated focal and rotational activation in persistent atrial fibrillation (AF). However, whether such an activation is observed at the same site also during a mid-term follow-up remains unknown.
Objective: We sought to compare the distribution of focal and rotational activation between the de novo and repeat ablation procedure in persistent AF patients.
Methods: Patients who had undergone pulmonary vein isolation (PVI) alone for (longstanding) persistent AF in the de novo ablation and underwent a repeat ablation for recurrences of AF were studied. Bi-atrial mapping was performed using a multi-spline catheter during AF after PVI in both the de novo and repeat ablation procedure. Electrograms acquired by mapping were analyzed offline by CARTOFINDER, which automatically identifies focal and rotational activation. No left atrial ablation except PVI was performed during the de novo ablation.
Results: Seventeen patients (61±9 years, 15 males) who underwent a repeat ablation for recurrences of AF were included. Duration between the de novo and repeat ablation was median of 107 days (interquartile range: 91-171 days). Of 105 focal and 19 rotational activation identified during the de novo ablation, 89 (85%) and 12 (63%) were identified also during the repeat ablation. Additionally, 39 focal and 9 rotational activation were newly identified during the repeat ablation. Focal activation identified during both the de novo and repeat ablation more likely to display a greater number of focal events than that identified during the de novo ablation alone (21±18 vs. 5±2, p=0.005). The number of rotational events was similar between the rotational activation identified during both ablation and that identified during the de novo ablation alone (median: 15.0 [IQR: 9.8-18.6] vs. 16.9 [13.0-18.9], p=0.6).
Conclusion: This study demonstrated that a majority of focal and rotational activation identified during the ablation procedure were identified also during the repeat ablation procedure in patients with AF recurrences.