Abstract 16472: Large Area of Complex-Fractionated Atrial Electrograms Disrupt Identification of Rotors and Focal Sources for Atrial Fibrillation After Pulmonary Vein Isolation
Background: The mapping of the electrical propagation to identify the underlying mechanisms that perpetuate atrial fibrillation (AF) is difficult because of Complex-fractionated Atrial Electrograms (CFAE). We hypothesized that the organization of AF would facilitate the identification of rotors or focal sources (AF sources) after pulmonary vein isolation (PVI).
Methods: We prospectively enrolled 87 patients undergoing an ablation for persistent AF. SR was restored for at least 2 weeks prior to ablation. If SR could not be maintained, pulmonary vein isolation (PVI) and linear ablation were performed. Radiofrequency ablation was performed during induced AF. If AF was sustained or induced after the PVI, activation maps to identify AF sources (Rotor map) were created by a 64-pole basket catheter, 20-pole circular mapping catheter and CS catheter with the use of the Velocity system. A rotor was defined as follow: reproducible reentrant atrial activity which was repeatedly present for more than 40% of the 3.8 second observation time. A macro-rotor was defined as an activation circuit, which extended around the Line of the PVI or the mitral annulus. A micro-rotor was defined as an activation circuit other than a macro-rotor. Focal sources of AF were identified as sites with a centrifugal activation pattern, which was repeatedly present for more than 40% of the 3.8 second observation time. The accuracy of the Rotor map was confirmed by the termination of AF. The endpoint of the procedure was the non-inducibility of AF lasting for more than 5 minutes. CFAE maps were created after PVI using a basket catheter, circular mapping catheter, and CS catheter.
Results: SR was maintained in 52 patients (60%). Rotor maps were created in 25 patients (29%). Seventeen AF sources were identified in 15 patients. The sources were left atrial in 16, and right atrial in 1, and 15 were rotors. Non-inducibility was confirmed in 38 patients (46%). The percentage of CFAE points was higher in the unsuccessful Rotor maps than in the successful Rotor maps (36% vs. 13%, p<0.01).
Conclusions: Rotor maps after organization of AF were useful for identifying AF sources. Rotor maps could not be created in patients with large CFAE areas.
Author Disclosures: Y. Hama: None. Y. Matsudo: None. T. Kuwahara: None. H. Fujimaki: None. N. Eguchi: None. I. Terabayashi: None. K. Kamishita: None. B. Katsu: None. S. Tanaka: None. N. Tonoike: None. K. Hou: None. T. Sekine: None. Y. Fujimoto: None. M. Yamamoto: None. T. Himi: None.
- © 2014 by American Heart Association, Inc.