B-PO02-113 MAPPING AND ABLATION OF ELECTRICAL DRIVERS ARE ASSOCIATED WITH DECREASED ATRIAL FIBRILLATION RECURRENCE IN PATIENTS WHO FAILED PRIOR PULMONARY VEIN ISOLATION

Abstract

The mechanisms for the recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI) are unclear. Prior studies have reported that AF drivers are a possible mechanism for the recurrence of AF. However, the characteristics and outcomes after ablation of AF drivers are not well defined. To identify the prevalence, characteristics and recurrence of AF after AF driver mapping and ablation in patients who failed prior PVI. Patients who underwent repeat ablation for recurrent AF after PVI were analyzed retrospectively. The prevalence of PV reconnections, AF drivers and focal triggers was identified. In patients without clear triggers, the presence of AF drivers was identified using either non-contact dipole density mapping (AcQMap, Acutus) or contact phase mapping (FIRMmap, Abbott). Recurrence of AF after repeat ablation was also analyzed in all patients. In 75 patients with recurrent AF, PV reconnections were found in only 46 patients (61%) and 29 patients (39%) had persistently isolated PVs. AF driver mapping was performed in 33 patients (44%) and of these 31 patients (94%) were found to have at least one AF driver (average drivers found was 2.8±1.1 drivers/patient). The most common locations were the LA anterior and posterior walls. AF driver mapping and ablation resulted in decreased likelihood of recurrence of AF when compared to patients who did not undergo AF driver mapping (HR 0.048, 95% CI 0.005-0.444 p=0.007). AF Drivers may be a dominant AF mechanism in patients with recurrent AF after PVI. Mapping and ablation of these drivers may result in decreased recurrence of AF. Prospective studies are needed to confirm these findings.