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

D-PO04-186 - Probabilistic Wavefront Analysis Of Panoramic Mapping Data Demonstrates Preferential Pathways Of Atrial Fibrillation And Predicts Pulmonary Vein Isolation Outcome (ID 488)


Background: AF appears chaotic and disorganized, which impedes characterization of the underlying substrate and treatment planning. While globally chaotic, there may be local preferential activation pathways that represent potential ablation targets.
Objective: To identify preferential activation pathways during AF and predict ablation outcome when these are targeted by pulmonary vein isolation (PVI).
Methods: In persistent AF patients (n=14), simultaneous biatrial contact mapping with basket catheters was performed pre-ablation and following each ablation strategy. Unipolar wavefront activation directions were averaged over 10s to identify preferential activation pathways. Clinical cases were classified as responders or non-responders to PVI during the procedure. Clinical data were augmented with a virtual cohort of 100 models.
Results: Preferential pathways were clearly visible for macro re-entrant tachycardia (Fig A), and roof ablation lines interrupted pathways, providing validation. In AF pre ablation, pathways originated from the PV antra in PVI responders (7/7, Fig B), but not in PVI non-responders (6/6, Fig C). We propose a novel index that measures activation waves from the PV antra into the atrial body. This index was significantly higher in PVI responders than non-responders (clinical: 16.3% vs 3.7%, p=0.04; simulated: 21.1% vs 14.1%, p=0.02).
Conclusion: This novel technique demonstrates that preferential activation pathways exist during AF. Targeting patient specific activation pathways that flowed from the PV antra to left atrial body using PVI terminated AF. These PV activation flow pathways may correspond to the presence of drivers in the PV regions.