Basic/Translational Science -> Intact Heart Electrophysiology (includes Pharmacology and Optical Mapping) D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-203 - Improving Atrial Fibrillation Ablation By Combining Epicardial ECGI Mapping And Endocardial Mapping Of Critical Regions (ID 142)


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Background: Ablation of localized regions of atrial fibrillation (AF) is being tested by multiple technologies, but may not terminate AF. Since epicardium and endocardium may differ in AF, we hypothesize that critical regions missed on mapping could explain lack of acute termination.
Objective: To study critical regions for AF by concurrent epicardial Electrocardiographic Imaging (ECGI) and endocardial basket-mapping in cases where ablation did/did not terminate AF.
Methods: Analysis of 64-poles location-tracked basket (Abbott) intracardiac electrograms of 17 AF patients (14 persistent, 67±9 y) by activation and phase mapping was used to guide ablation. Simultaneous ECGI maps were reconstructed from 62 surface electrodes, with regions of interest identified by phase analysis.
Results: AF terminated during ablation in 7 patients by targeting 5±2 critical regions. Endocardial map coverage was smaller in non-termination vs. termination patients (64±18% vs 80±10%, p=0.03). ECGI maps showed more critical AF regions outside panoramic endocardial maps (<1cm) in non-termination than termination patients, both in density (4.5±2.4 vs 2.6±1.6, p=0.08) and total number of regions (1±1 vs 6±2, p=0.01, Fig. C).
Conclusion: Lack of acute AF termination by ablation at critical sites could in part reflect lack of adequate mapping. Combining epicardial ECGI mapping with current endocardial tools increases sensitivity to detect critical AF regions than either alone, and may improve outcomes.