Abstract
Using endocardial spectral mapping in sinus rhythm we have found 2 kinds of atrial myocardium: the fibrillar with rightward-segmented spectrum - named AF-Nest - and the compact with leftward non-segmented spectrum. By inducing AF we have consistently observed very high-disorganized activation only in the AF-Nest [reactive resonant tissue] while the compact keeps well-organized rather regular activation [passive tissue]. These findings suggest that AF-Nests resonance plays a crucial role in AF physiopathology refeeding the arrhythmia. Describe the AF treatment by AF-Nests catheter RF-ablation. 81 p (68M, 51.6±10y) with very frequent refractory AF, paroxysmal 56(Px) and persistent 25(Ps) without significant cardiopathy (LA 42±6mm). Catheter RF-ablation [EPT 4mm] guided by spectral mapping in sinus rhythm outside pulmonary veins (PV). Endpoints: 1. AF-nests RF-ablation [60°/30J/30s] shifting its spectrum to the compact pattern; 2. Focal ablation of any residual atrial tachycardia/flutter (AT); 3. AF non-inducibility by atrial pacing and 4. Long-term control with serial EKG and Holter. A mean of 49±19 AF-nests/p were treated. At the FU of 11.2±7months 88,8% p have no AF. After AF-nests ablation: it was impossible to reinduce AF in 71% Px and in 33% Ps. Non-sustained AF (<10s) was induced in 29% Px and in 44% Ps. Sustained AF was only induced in 22% Ps; residual AT was also induced and treated in 26%. In 23.5% a healing coarse AF/AT was observed [1.5±1 day] readily responsive to brief medical treatment. 11% p were successfully reablated (residual AF-Nests/AT). 22% p is taking low AA dose. AF-Nest location: LA roof 100%, LS/RS PV insertion 89%, LIA septum 86.4%, RI/LI PV insertion 68%, septal posterior 70%, RA 63%. 2 pericardial effusions occurred 1 clinically and 1 surgically treated. By spectral mapping the AF-Nests were easily found and ablated; During the AF the AF-Nests play a reactive resonant role while the compact plays a passive one; After all AF-nest ablation it was impossible to reinduce AF; Regular residual AT must be sought to be treated in the same procedure; The AF-nest ablation outside PV is safe, feasible and very efficient to cure A
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