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

D-PO04-192 - Meandering Rotors Contribute As Non-paroxysmal Atrial Fibrillation Driver In Older Patients Than In Younger Patients: Extra Mapping Project (ID 1229)


Background: Rotational activations are believed to be involved in the mechanisms of atrial fibrillation (AF) persistency. However, the exact mechanisms and the relationship of AF wave dynamics to structural remodeling are not well-known since the optimal method detecting AF drivers is still controversial in clinical practice.
Objective: To detect AF drivers and clarify their characteristics.
Methods: During catheter ablation, the online and real-time high-spatiotemporal density AF imaging system developed by our group (ExTRa Mapping system) was employed. Then this system was applied to consecutive 76 patients with pulmonary vein isolation (PVI)-refractory non-paroxysmal AF (Non-PAF) (64±9 y/o, 74% male, 57% long-standing). Among the ExTRa Mapping movies obtained in whole left atrium (LA), we analyzed non-passive rotational activation (NP) assumed to contain AF drivers, and investigated the factors that affect their patterns of AF wave dynamics, i.e., patients' characteristics and echocardiographic measurements, using multiple-linear regression.
Results: (1) The areas of NP (40±10%) in forms of meandering rotors (MR) (27±6%) and/or multiple wavelets (MW) (13±6%) were observed (Fig, left). (2) Both MR and MW were frequently observed in the LA floor (Fig, top right). (3) Both age and Non-PAF duration were independent related factors increasing NP. However, age rather than Non-PAF duration was a significant factor increasing the MR-to-NP ratio (Fig, bottom right).
Conclusion: The mechanisms of AF persistency might change with age rather than Non-PAF duration. The ExTRa Mapping system provided better understanding of PVI-refractory Non-PAF drivers.