Abstract
BackgroundCharge density mapping of atrial fibrillation (AF) reveals dynamic localized rotational activation (LRA), irregular activation (LIA) and focal firing (FF). Their spatial stability, conduction characteristics and the optimal duration of mapping required to reveal these phenomena and has not been explored.MethodsBi‐atrial mapping of AF propagation was undertaken using AcQMap (Acutus Medical) and variability of activation patterns quantified up to a duration of 30 s. The frequency of each pattern was quantified at each unique point of the chamber over two separate 30‐s recordings before ablation and R 2 calculated to quantify spatial stability. Regions with the highest frequency were identified at increasing time durations and compared to the result over 30 s using Cohen's kappa. Properties of regions with the most stable patterns were assessed during sinus rhythm and extrastimulus pacing.ResultsIn 21 patients, 62 paired LA and RA maps were obtained. LIA was highly spatially stable with R 2 between maps of 0.83 (0.71–0.88) compared to 0.39 (0.24–0.57), and 0.64 (0.54–0.73) for LRA and FF, respectively. LIA was most temporally stable with a kappa of >0.8 reached by 12 s. LRA showed greatest variability with kappa >0.8 only after 22 s. Regions of LIA were of normal voltage amplitude (1.09 mv) but showed increased conduction heterogeneity during extrastimulus pacing (p = .0480).ConclusionIrregular activation patterns characterized by changing wavefront direction are temporally and spatially stable in contrast with LRA that is transient with least spatial stability. Focal activation appears of intermediate stability. Regions of LIA show increased heterogeneity following extrastimulus pacing and may represent fixed anatomical substrate.
Highlights
The limited efficacy of pulmonary vein isolation for the ablation of persistent atrial fibrillation has resulted in concerted efforts to identify nonpulmonary vein mechanisms responsible for AF maintenance
Ultrasound is used to generate a high resolution 3‐dimensional reconstruction of the atrial chamber anatomy based on a triangular mesh structure comprising constituent corners of triangular faces, which form the unique points for calculation of inverse derived charge density signals
localized irregular activation (LIA) is characterized by a difference in angle between conduction that enters and leaves a confined region exceeding a threshold of 90°
Summary
The limited efficacy of pulmonary vein isolation for the ablation of persistent atrial fibrillation (persAF) has resulted in concerted efforts to identify nonpulmonary vein mechanisms responsible for AF maintenance. This has led to the development of techniques to facilitate mapping of the underlying atrial electrophysiology with the aim of revealing fibrillatory mechanisms and guiding targeted ablation.[1,2,3,4,5,6]. | 2395 patterns were explored using long and short cycle length pacing and electroanatomic voltage mapping in sinus rhythm
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