Identification and ablation of atrial drivers in patients with persistent atrial fibrillation

Abstract

Objective To investigate the efficacy of driver-guided ablation for the treatment of persistent atrial fibrillation (AF) . Methods Between July 2017 and March 2018, 47 consecutive patients with persistent AF underwent endocardial catheter ablation in Beijing Chaoyang Hospital. Among those, 35 patients [ (67±12) years, 22 males, 11 (31%) long-standing persistent AF, mean persistent AF duration (12±15) months] maintained AF after circumferential pulmonary vein isolation, in whom, high-density mapping using PentaRay catheter and driver-guided ablation were performed. Electrograms displaying spatial dispersion and faster frequency than those from the adjacent sites were indicative of drivers of AF and were targeted for ablation. Cardioversion was performed if AF was refractory to 20 minutes atrial ablation. Results In total, 78 drivers were identified in 35 patients [ (2.2±0.9) per patient] , with a mean cycle length of (142±24) ms. Drivers were mainly distributed at left atrial roof (29.5%) , left atrial septum (15.4%) , left atrial bottom (15.4%) , base of left atrial appendage (11.5%) , left atrial posterior wall (7.7%) , left atrial anterior wall (6.4%) , left atrial lateral wall (5.1%) , and right atrium (9.0%) . Driver-guided ablation achieved AF termination in 28 (80.0%) patients, in whom, 17 converted to sinus rhythm and 11 organized to atrial tachycardia. Cardioversion was performed in 7 patients. During a mean follow-up period of (8.4±2.6) months, the success rate after one single procedure was 80.0% (28/35) . Conclusion In patients with persistent AF, ablation of drivers defined by electrogram characteristics via high-density endocardial mapping could achieve excellent acute AF termination rate and short-term success rate. Key words: Catheter ablation; Atrial fibrillation; Driver