Abstract
Catheter ablation for persistent atrial fibrillation (AF) has shown limited success. The vector field (VF) mapping illustrates the stationary waveform propagating during AF, can compute the global propagation patterns to demonstrate the mechanism of AF maintenance. This study aimed to visualize the global wavefront pattern during AF by using VF mapping and investigate the ablation outcome based on different pattern. In phase 1 study, we applied a cellular automation technique to simulate the electrical wave propagation to improve the VF mapping algorithm, involving analysis of high similarity electrogram vectors to to display the stable wave propagation of AF. In the phase 2 study, patients with persistent AF underwent catheter ablation were prospectively enrolled. (Group 1 [N=35]: AF drivers emanating from 1 or more PVs; Group 2 [N=30]: No AF drivers emanating from 1 or more PVs). VF mapping and PRISM-guided PVI was performed in all patients. The patient characteristics and procedural data were extracted for analysis. We evaluated the single-procedure freedom from AF after first ablation procedure. We identified an average of 2.7±2.0 VF regions per patients. These regions (N=177) involved PV (N=100) and left atrium (N=77). A higher procedural AF termination rate (43%vs. 17%, P=0.03) was achieved in Gp-1 than Gp-2. Gp-1 patients had a significant reduction in all arrhythmia recurrence compared to Gp-2. After multivariate analysis, the behavior of driver emanating from PV (Hazards ratio [HR] 0.426, 95% confidence interval [CI]: 0.187-0.968, P =0.042) and the left atrial diameter (HR 1.092, 95% CI: 1.021-1.169, P = 0.011) independently predicted the recurrence. VF mapping of persistent AF revealed the waveform dynamic of the entire atrial chamber and revealed the spatially stable AF drivers with sink-to-source phenomenon to the rest of the atrium. The arrhythmogenic drivers within PVs/antra are predictive of the successful PV isolation in patients with persistent AF.
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