Abstract 16564: Location of Persistent Atrial Fibrillation Drivers Based on Body Surface Mapping: A Systematic Review and Metanalysis

Abstract

Introduction: Body Surface Mapping (BSM) is a non-invasive electrocardiogram-based mapping system that is used to identify localized drivers in patients with persistent Atrial Fibrillation (AF). Mapping of local drivers is becoming increasingly important in guiding treatment of atrial fibrillation but may not be readily available. We conducted a systematic review to determine the most prevalent atrial regions of AF driver activity identified with BSM. Methods: Electronic literature searches were performed across PubMed, Google Scholar, Cochrane, CINAHL, Web of science, EMBASE databases up to January 2019, for studies that utilized BSM to identify and report localized focal and rotor (reentrant) driver activity. Prevalence of drivers, as a percentage, were recorded for every region according to the Bordeaux Biatrial Schema. Random-effects model was used to calculate weighted averages with the corresponding 95% confidence interval (CI). Results: Total of 468 unique studies were identified and reviewed. 4 prospective cohort studies were included in the final analysis—of which 3 were single-center and 1 was multi-centered; totaling 336 patients. The mean age was 62.8 (±5.41) and 73% were males. The three most prevalent regions with persistent AF foci activity were region 1 (left pulmonary veins and left appendage): 59% (CI 48-71), followed by region 4 (upper half of right atrium and appendage): 31% (CI 12-54), and region 2 (right pulmonary veins and posterior interatrial groove): 19% (CI 7-34). The three most prevalent regions of persistent AF rotor activity were region 3 (inferior and posterior left atrium): 71% (CI 32-98), region 1: 70% (CI 21-100), and region 2: 70% (CI 25-99). Conclusion: In patients with persistent AF, majority of localized drivers seem to originate from specific atrial regions based on BSM.