Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Mapping & Imaging D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-191 - Mapping Persistent Atrial Fibrillation With Electrogram Recurrence (ID 1228)

Abstract

Background: While various mapping approaches have been proposed for clinical mapping of persistent atrial fibrillation (PeAF), none have become established. Electrogram (EGM) morphology recurrence (EMR) quantifies consistency of activation direction at each site and is expected to be high near drivers of PeAF.
Objective: To compare EMR in the left (LA) versus right atrium (RA).
Methods: 30 patients (23 males, mean age 63±10 years, CHA2DS2-VASc 2.2 ±1.7, ejection fraction 49 ± 10%) with PeAF undergoing catheter ablation were enrolled. Multipolar catheters were used to record bipolar EGMs from the LA (227±155 sites) and RA (187±151 sites) before ablation. EMR was calculated by cross-correlation of each automatically detected EGM with every other EGM in the recording. The most recurrent EGM morphology was identified and its frequency (Rec%) and cycle length of recurrence (CLR) were computed. The minimum CLR site was identified as well as shortest CLR sites (within 5 ms of the minimum).
Results: Patients had 1 ( n=19), 2 (n=10), or 3 (n=1) areas of shortest CLR in the LA (n= 23) and RA (n=10), most frequently in the pulmonary veins (11/30, 37%).Overall minimum CLR was 193.0±33.9 ms, with Rec% of 91±14% (LA-205.1±44.7 versusRA 222.7±43.7, p=0.08). Table shows CLR and Rec% by site with the distribution of short CLR by region.
Conclusion: Although the pulmonary veins account for the sites of highest Rec% and most frequently the shortest CLR (37%), a substantial number of patients have shortest CLR in the RA (33.3%). EMR may help identify RA and extrapulmonary LA drivers for PeAF.
Shortest recurrence cycle length (CLR) and highest recurrence percentage (Rec %) by site
AtriumRegionShortest CLR (mean ± SD, ms)Median Shortest CLR (InterQuartile Range, ms)Number of patients with shortest CLR at siteHighest Recurrence (mean ± SD, %)
Right Atrium (RA)SVC300.7 ± 83.7297.5 (245.0 -336.7)375.9 ± 17.6
RAA275.4 ± 58.8265.0 (240.5 -304.8 )273.2 ± 15.9
Septal RA285.2 ± 75.0295.5 (223- 342.5)375.7 ±17.5
Other RA242.8 ± 48.9236.0 (212.8 -260 )277.6 ±15.2
Left Atrium (LA)All Pulmonary veins235.2 ± 78.7208.0 (188.0- 255.8)1190.9 ± 14.5
Posterior LA301.5 ± 145.2240.0 (200.5 - 357.5)371.3± 24.7
Septal LA310.7 ± 180.5252.5 (223.8 -328.3)470.9 ± 22.3
Other LA260.8 ± 76.9244.5 (204.5 - 289.3)377.4 ± 16.6
LAA309.1 ± 99.5276.5 (233.5 - 349.0)171.0 ± 18.4

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