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

D-PO04-195 - Spatiotemporal Stability Of Conduction Patterns In Persistent Atrial Fibrillation: Insights From The UNCOVER AF Trial (ID 1230)


Background: Non-contact charge density (NCCD) mapping (AcQMap, Acutus Medical) has identified three distinct non-pulmonary vein (PV) conduction patterns in patients with persistent AF (PersAF): focal (F); localized rotational activation (LRA); and localized irregular activation (LIA). Targeting these areas for ablation, in addition to PV isolation (PVI) has been shown to decrease arrhythmic burden, however characterization of these patterns is incomplete.
Objective: Assess spatiotemporal stability of NCCD-identified conduction patterns in persAF.
Methods: NCCD maps were generated from pre-PVI recordings in 20 patients enrolled in the UNCOVER AF trial who underwent de novo catheter ablation for persAF. Patterns were assessed in 7 distinct recording epochs (1, 2, 5, 10, 15, 20, and 30 s). The top 30% of detected patterns for each epoch were compared to the previous epoch. Median spatial percentage overlap throughout the 30 s windows was calculated for each pattern and compared across epochs.
Results: A total of 140 recordings were analyzed. Over the entire 30 s, the percentage spatial overlap (median, IQR) was: F (0.49, 0.38 - 0.66); LRA (0.65, 0.51 - 0.75); LIA (0.42, 0.23 - 0.65). F and LRA patterns were similar (p = 0.224), while LIA had statistically significantly higher percentage spatial overlap than F (p = 0.035) and LRA (p = 0.009) (Figure). Furthermore, LIA stabilized at 15 s, while F and LRA failed to stabilize over 30s.
Conclusion: In PersAF, NCCD-identified LIAs displayed the highest spatial consistency and stabilization compared to F and LRA patterns, as expected given the intermittence of F and LRA. LIA may be a more reliable metric for identifying non-PV ablation targets in PersAF.