136-24: Comorbidities Influence the Inability of Classical Activation Mapping to Identify Sites Where Ablation Terminates Persistent AF

Abstract

Introduction: Phase mapping or activation mapping may reveal AF drivers in different patients, but it is unknown what factors challenge this process. We hypothesized that greater fibrillatory substrate in patients with more comorbidities explain why AF drivers shown by phase mapping are unresolvable by classical mapping. Results: In 5/24 (21%) patients, isochronal maps showed earliest meets latest circular wavefronts in agreement with phase-identified rotors. However, advanced substrate increased the complexity of electrograms, reduced map accuracy and resulted in partial concordance in 13/24 (54%) and 6/24 (25%) were unresolvable. Increased BMI, Age, and CHADS2 score identified the unresolvable group (fig B). Conclusions: Comorbidities (age, BMI, and CHADS2 score) produced more complex fibrillatory substrate. Classical activation maps of AF in these patients were less likely to identify sites where phase-mapping was able to identify rotors where ablation terminated AF. These results highlight the need to individualize AF mapping in the presence of significant comorbidities.