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Identification of active atrial fibrillation sources and their discrimination from passive rotors using electrographical flow mapping

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Abstract

Background

The optimal ablation approach for the treatment of persistent atrial fibrillation (AF) is still under debate; however, the identification and elimination of AF sources is thought to play a key role. Currently available technologies for the identification of AF sources are not able to differentiate between active rotors or focal impulse (FI) and passive circular turbulences as generated by the interaction of a wave front with a functional obstacle such as fibrotic tissue.

Objectives

This study introduces electrographic flow (EGF) mapping as a novel technology for the identification and characterization of AF sources in humans.

Methods

Twenty-five patients with AF (persistent: n = 24, long-standing persistent: n = 1; mean age 70.0 ± 8.3 years, male: n = 17) were included in this prospective study. Focal impulse and Rotor-Mapping (FIRM) was performed in addition to pulmonary vein isolation using radiofrequency in conjunction with a 3D-mapping-system. One-minute epochs were exported from the EP-recording-system and re-analyzed using EGF mapping after the procedure.

Results

44 potential AF sources (43 rotors and one FI) were identified with FIRM and 39 of these rotors were targeted for ablation. EGF mapping verified 40 of these patterns and identified 24/40 (60%) as active sources while 16/40 (40%) were classified as passive circular turbulences. Four rotors were not identified by EGF mapping.

Conclusion

EGF is the first method to identify active AF sources during AF ablation procedures in humans and discriminate them from passive rotational phenomena, which occur if the excitation wavefront passes conduction bariers. EGF mapping may allow improved guidance of AF ablation procedures.

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Abbreviations

AF:

Atrial fibrillation

FI:

Focal impulse

EGF:

Electrographic flow

FIRM:

Focal impulse and Rotor-Mapping

PVI:

Pulmonary vein isolation

SR:

Sinus rhythm

INR:

International normalized ratio

ACT:

Activated clotting time

LA:

Left atrium

RA:

Right atrium

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Authors and Affiliations

  1. Department of Cardiology - Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany

    Barbara Bellmann, Marit Zettwitz, Selma Guttmann, Verena Tscholl, Patrick Nagel, Mattias Roser & Andreas Rillig

  2. Heartcare Victoria, Melbourne, Australia

    Tina Lin & Ulf Landmesser

  3. Ablacon Inc, Calistoga, USA

    Peter Ruppersberg

Authors
  1. Barbara Bellmann
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  2. Tina Lin
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  10. Andreas Rillig
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Correspondence to Andreas Rillig.

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Bellmann, B., Lin, T., Ruppersberg, P. et al. Identification of active atrial fibrillation sources and their discrimination from passive rotors using electrographical flow mapping. Clin Res Cardiol 107, 1021–1032 (2018). https://doi.org/10.1007/s00392-018-1274-7

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  • DOI: https://doi.org/10.1007/s00392-018-1274-7

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