Abstract 17409: Complex Electrical Substrates in Patients With High BMI and CHADSVASc Obscure Mapping of Rotational AF Drivers in Persistent AF
Introduction: Since traditional methods of mapping fail to reveal localized AF drivers, it is unexplained how ablation of limited areas guided by phase mapping can terminate persistent AF. We hypothesised that structural remodelling (LA size, raised BMI and high CHADSVASc) may reconcile traditional and phase mapping of AF.
Methods: We recruited 60 patients at 5 international centers in whom persistent AF terminated by localized ablation (area <3 cm2) targeted by rotor mapping before other ablation or PVI. Using non-commercial analysis methods, we annotated activation traditionally over 4s of AF from 64 pole baskets using -dv/dt or peak amplitude criteria, compared to phase. We studied sites of ablation-related termination, and tested if discrepancies related to electrical or structural substrates.
Results: Each patient had AF termination (52% to sinus) by localized ablation, in whom we analyzed 550 activation (isochronal) maps. Unexpectedly, rotational sources were found by activation mapping, confirming phase maps in 15/60 (25%) cases (Figure A). Remaining cases had partial (45%) or no (30%) agreement (p<0.05) for reasons including difficulties in marking activation of complex electrograms. Such cases associated with higher BMI, CHADSVASc > 3 but not LA size or AF duration (table).
Discussion: For the first time, this international study reveals rotational drivers of persistent AF by traditional mapping, focused at sites of known AF termination rather than arbitrary regions. However, traditional mapping was less sensitive than phase mapping for AF drivers, due to the impact of BMI and CHADSVASc substrates on electrograms. These data highlight the role of mapping technique in AF to guide ablation.
- Arrhythmia mapping
- Arrhythmias, treatment of
- Atrial fibrillation
- Ablation, radiofrequency
Author Disclosures: J.A. Zaman: Research Grant; Significant; Fulbright Commission, British Heart Foundation. M.I. Alhusseini: None. T. Baykaner: None. R.T. Borne: None. C.A. Kowaleski: Research Grant; Significant; Siemens. N.S. Peters: Research Grant; Significant; British Heart Foundation. W.J. Rappel: Consultant/Advisory Board; Modest; Topera Inc. W.H. Sauer: Research Grant; Modest; Receives significant research grants from Biosense Webster and CardioNXT and educational grants from St Jude Medical, Boston Scientific, and Medtronic. Ownership Interest; Modest; Has non-public equity interests/stock options in CardioNXT. Other; Modest; Has a provisional patent on partially insulated focused catheter ablation. J. Brachmann: None. D.E. Krummen: Other Research Support; Modest; Medtronic, Boston Scientific, St. Jude, Biotronik, Biosense-Webster. Consultant/Advisory Board; Modest; Topera. J.M. Miller: Consultant/Advisory Board; Modest; Topera Inc, Medtronic, Boston Scientific, St Jude Medical, Biosense Webster. S.M. Narayan: Research Grant; Significant; National Institute for Health. Honoraria; Modest; Medtronic, St Jude Medical, Biotronik, Boston Scientific Corp. Ownership Interest; Significant; Topera Inc.
- © 2016 by American Heart Association, Inc.