Abstract 13636: Regional Distribution of Mapped Stable Organized Tachyarrhythmias ("Rotors") in Paroxysmal and Persistent Atrial Fibrillation:
Introduction: Stable organized atrial tachyarrhythmias (ATs) /"rotors" have been identified during biatrial activation mapping in patients (pts) with atrial fibrillation (AF) but their propensity to locate in specific right (RA) & left atrial (LA) regions & activation patterns have not been well studied.
Methods: We performed simultaneous contact catheter mapping of the RA & LA with 3 dimensional non-contact mapping (NCM - St. Jude Ensite Balloon Array) in 81 refractory AF pts during spontaneous AF events. Spontaneous ATs were analyzed. We compared regional location & spectrum of ATs in paroxymal AF (PAF) & persistent AF (PRAF) pts.
Results: 101 spontaneous ATs.( Figure, left panel) in pts with PAF (n=24) or PRAF (n=57) were mapped 8 pts had no AF events and 3 pts had unmappable AF. Organized stable ATs/"rotors" were recorded in all 73 pts (90%) with mapped spontaneous AF at its onset, early maintenance & were often apparent in established AF.(Figure, right panel) Stable ATs with focal activation patterns were infrequent in regions other than superior LA/pulmonary veins. Cavotricuspid isthmus (CVI) flutter was equally frequent in PRAF and PAF pts (46% vs. 36%, p=0.4) but other ATs/"rotors" were more frequent with PRAF than PAF in the RA (37% vs. 25%, p=0.4 ) and LA (29% vs. 10%, p=.125) . The incidence of ATs/"rotors" in the vicinity of the mitral isthmus was more prevalent in PRAF (p<0.05).
Conclusions: 1.Biatrial activation mapping with high resolution electrode arrays is essential to localize and define regional atrial involvement with ATs/"rotors" in AF. 2. There is involvement of widely disparate RA & LA regions in the generation of ATs/"rotors" in both PAF and PRAF. 3. ATs/"rotors" exist in the RA and LA independent of pulmonary vein and CVI flutter origin and are more frequent in PRAF than PAF. 4.Improvement in targeting atrial regions for catheter ablation may result from mapping ATs/"rotors".
- © 2013 by American Heart Association, Inc.