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

D-PO04-156 - Substrate Characteristics And Long-term Outcome Of Patients With Persistent Atrial Fibrillation Based On Morphological Repetitiveness By Periodicity And Similarity (PRISM) (ID 472)


Background: The optimal ablation approach in patients with persistent AF is not clear. We hypothesized that the morphologic repetitiveness of the electrogram may be associated with AF sources.
Objective: This study aimed to evaluate this new mapping and ablation strategies additional to PVI.
Methods: We prospectively enrolled 69 persistent AF patients (Group 1) undergoing catheter ablation by using CARTO 3 system (UDM module), and compared them to matched PVI ablation controls (N=67, Group 2). During AF, the regional distribution of the high PRISM Index could be divided into 2 types, and was used to guide ablation, including: Type 1, wide circumferential PVI if high PRISM sites were located only or near PVs, only wide PVI was applied (N=30); Type 2, PVI plus substrate ablation, encircling high PRISM sites outside the PV (N=39)
Results: An average of 3.0 ± 1.2 regions with high PRISM index per chamber were identified in 100% of patients. Baseline features were similar, and the immediate outcomes of the different approaches were similar, except more LSPAF in type 2 patients. There were more non-PV triggers in the patients with type 2 PRISM map. Termination rate was higher in Type 1. 94.2 % of the termination sites were within the high PRISM site. 29.2 % of non-PV triggers were localized within the high PRISM area. Better long-term AF freedom was observed as compared to the matched controls with PVI only (P=0.004).
Conclusion: The regional distribution of the high PRISM index area provided an optimal guide for persistent AF substrate ablation. The high degree of morphology repetitiveness and periodicity region indicated the AF drivers of the non-PV regions nearby and high response rate to catheter ablation