Abstract 18311: Demonstration That Focal Atrial Tachycardia Outside the Pulmonary Veins Can Drive Persistent Atrial Fibrillation: Insights From Classical and Panoramic Mapping
Background: It is known that AF can be initiated by focal triggers near the pulmonary veins (PV), yet it is unproven if human AF can be sustained by repetitive focal atrial tachycardias (sources) remote from these sites. We hypothesized that panoramic mapping may reveal organized focal AF sources proven by centrifugal activation, that occupies a small percentage of AF cycle length and ablation at the source resulting in sinus rhythm, which would be undetected using classical mapping techniques.
Methods: We performed global contact mapping of patients at AF ablation, with basket catheters at 3 centers. We selected cases with centrifugal activation from an origin during AF, in whom atrial electrograms on basket catheters spanned <50% of AF cycle length, and in whom localized ablation at this origin acutely terminated AF.
Results: Sixteen patients (age 64.6±8.4yrs, LA vol. index 2.1±0.1ml/m2, LVEF 55.3±6.3%) met a priori criteria for focal AF sources. Figure A shows AF in a 56 year old woman (see coronary sinus), yet 4 sequential panoramic maps (B) showed repetitive centrifugal non-uniform activation, (C) with organized electrograms spanning <50% AF CL (blue arrow). This AF-driving focal tachycardia lay within a 2-3 cm2 area between cycles. Directed ablation at this site alone terminated AF to sinus rhythm and rendered AF/AT non-inducible. Focal drivers lay in both left and right atria, away from the PVs in 75% of cases.
Conclusions: We present proof that focal atrial tachycardias away from the PVs may drive persistent AF, meeting classical electrogram criteria for focal sources, producing fibrillatory conduction, where targeted ablation eliminated AF. Future studies should determine how focal sources may relate to rotational circuits, e.g. on the opposite atrial wall, and their relationship to AF triggers.
Author Disclosures: J.A. Zaman: Research Grant; Significant; Fulbright Commission, British Heart Foundation. R.T. Borne: None. T. Baykaner: Research Grant; Significant; Heart Rhythm Society. S. Park: Honoraria; Modest; Medtronic. M. Viswanathan: Honoraria; Modest; Biosense Webster. P.J. Wang: Research Grant; Modest; Medtronic, Siemens, Cardiofocus, ARCA. Other Research Support; Modest; Fellowship Support: Medtronic, St Jude Medical, Boston Scientific Corp, Biosense Webster. Honoraria; Modest; Janssen, St. Jude Medical, Medtronic, Amgen. Ownership Interest; Modest; Vytronus. Consultant/Advisory Board; Modest; Janssen, St. Jude Medical, Medtronic, Amgen. D.E. Krummen: Other Research Support; Modest; Medtronic, Boston Scientific, St. Jude, Biotronik, Biosense-Webster. Consultant/Advisory Board; Modest; Topera. 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. 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.