Allied Professionals (Non-physician submissions only) -> Clinical Research D-AB01 - The Wide Spectrum of Arrhythmia Care: EP Procedure to Follow-up (ID 24) Abstract

D-AB01-05 - Right Atrial Substrate Mapping In Persistent AF (ID 1426)


Background: Data is limited regarding right atrial activation patterns (RA) prior to left atrial ablation during persistent AF (PerAF).
Objective: To study the frequency and distribution of RA activation patterns during PerAF.
Methods: We studied pre-ablation RA charge density (Acutus Medical, Carlsbad, CA) maps of PerAF patients. 5s of AF activations between TQ intervals (excluding T waves) were studied and converted to propagation maps after noise exclusion. The RA was divided into 9 anatomical zones (Fig A). The RA activation map was slowed to 1/50th speed and analysed for different activation patterns, their frequencies & distributions.
Results: 16 patients were studied (25% long standing PerAF). A total of 118 TQ segments were studied with median 560ms (317 - 2176ms). A mean 165.6 +/- 12.7 activation patterns occurred in mean of 4.94 +/- 0.20 secs of PerAF giving a total of 2554 activation patterns in 80s of AF. Of these 21.1% (N=541,pink) were focal centrifugal activity, 3.1% (N=79,green) were complete rotational activity (≥270-degree rotation), 75.6% were local irregular activity (N=1934,yellow) (FigC). All patients had repeated occurrence of more than 2 types of activation patterns at posterior wall & septum junction (FigB). 48.7% of activation patterns were in the posterior wall & septum junction and 26.1% at the anterior RA/RAA.
Conclusion: The junction between RA posterior wall & septum is a new substrate with heterogenous conduction in PerAF. RAA also has significant activations occurring during AF, perhaps secondary to pectinate muscle fibres. The benefit of ablating these areas is currently under investigation.