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 (CL
R) were computed. The minimum CL
R site was identified as well as shortest CL
R sites (within 5 ms of the minimum).
Results: Patients had 1 ( n=19), 2 (n=10), or 3 (n=1) areas of shortest CL
R in the LA (n= 23) and RA (n=10), most frequently in the pulmonary veins (11/30, 37%).Overall minimum CL
R 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 CL
R and Rec% by site with the distribution of short CL
R by region.
Conclusion: Although the pulmonary veins account for the sites of highest Rec% and most frequently the shortest CL
R (37%), a substantial number of patients have shortest CL
R 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| Atrium | Region | Shortest CLR (mean ± SD, ms) | Median Shortest CLR (InterQuartile Range, ms) | Number of patients with shortest CLR at site | Highest Recurrence (mean ± SD, %) |
| Right Atrium (RA) | SVC | 300.7 ± 83.7 | 297.5 (245.0 -336.7) | 3 | 75.9 ± 17.6 |
| RAA | 275.4 ± 58.8 | 265.0 (240.5 -304.8 ) | 2 | 73.2 ± 15.9 |
| Septal RA | 285.2 ± 75.0 | 295.5 (223- 342.5) | 3 | 75.7 ±17.5 |
| Other RA | 242.8 ± 48.9 | 236.0 (212.8 -260 ) | 2 | 77.6 ±15.2 |
| Left Atrium (LA) | All Pulmonary veins | 235.2 ± 78.7 | 208.0 (188.0- 255.8) | 11 | 90.9 ± 14.5 |
| Posterior LA | 301.5 ± 145.2 | 240.0 (200.5 - 357.5) | 3 | 71.3± 24.7 |
| Septal LA | 310.7 ± 180.5 | 252.5 (223.8 -328.3) | 4 | 70.9 ± 22.3 |
| Other LA | 260.8 ± 76.9 | 244.5 (204.5 - 289.3) | 3 | 77.4 ± 16.6 |
| LAA | 309.1 ± 99.5 | 276.5 (233.5 - 349.0) | 1 | 71.0 ± 18.4 |
