B-PO03-092 DEPENDENCY OF OUTCOME ON ELECTROGRAPHIC FLOW MAPPING PARAMETERS

Abstract

Electrographic flow (EGF) mapping is a novel method of visualizing near real-time cardiac action potential flow to detect distinct AF mechanisms characterized by EGF parameters including source activity, active fractionation (FRC) and stable circuits (SC). Demonstrate outcome dependency of ablation on different EGF-based pathophysiologic phenotypes based on mechanisms of persistent AF. Using EGF mapping software, we retrospectively post-processed 1 minute pre- and post-ablation recordings of unipolar electrograms recorded from 64-electrode basket catheters in 199 patients who underwent FIRM-guided ablation at 3 centers. Each pre- and final post-ablation recording was classified by presence of EGF mechanisms: active sources; active fractionation; stable circuits with low flow angle variability. These mechanistic phenotypes, detected post ablation, were then correlated with clinical outcomes at 12 months post-ablation. Study population’s mean age was 63.6 ± 9.3 years, 30.7% female, mean duration of AF of 4.1 ± 3.4 years and mean LA size 50.1 mm. Kaplan Meier curves showed high 12 months freedom from AF (FFAF) of 93% for those without extra-PV mechanisms, i.e., AF not driven by stable extra-PV mechanisms. Patients with active sources had 21% FFAF and those without active sources but with both FRC and SC had 25% FFAF. Patients with FRC alone had 74% FFAF and those with SC alone had 69% FFAF. EGF mapping enables the dynamic detection of distinct AF mechanisms including active sources, active fractionation, stable re-entry circuits. The presence or absence of 1 or more of these AF mechanisms correlates with 12 months FFAF.