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Electrogram morphology recurrence guided catheter ablation for repeat ablation of persistent atrial fibrillation

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Abstract

Background

There are no standard mapping approaches for patients with persistent atrial fibrillation (PeAF), particularly after failed prior catheter ablation (CA). In this study, we assess the feasibility of using Electrogram Morphology Recurrence (EMR) to guide ablation.

Methods

Ten patients with recurrent PeAF after prior CA underwent detailed mapping of both atria during PeAF using the PentaRay (4 mm interelectrode spacing) and 3D mapping with CARTO. At each site, 15 s recordings were made. Custom software identified each electrogram and cross-correlation was used to identify the most recurrent electrogram morphology from which the % recurrence and cycle length of the most repeatable morphology (CLR) was calculated. Sites of shortest CLR and sites within 5 ms of shortest CLR with recurrence ≥ 80% were used to inform CA strategy.

Results

A mean of 342.9 ± 131.9 LA and 328.6 ± 91.5 RA sites were recorded per patient. Nine had PV reconnection. Shortest CLR sites guided ablation in 6/10 patients while 1 patient failed to fulfill shortest CLR criteria, and another 3 did not undergo CA guided by shortest CLR due to operator preference. On 12-month follow-up, all 4 patients without shortest CLR guided CA had recurrent PeAF. Of the 6 patients with shortest CLR guided CA, 5 patients did not have recurrent PeAF (p = 0.048), although 1 had paroxysmal AF and 2 had atypical atrial flutter.

Conclusion

EMR is a feasible, novel technique to guide CA in patients with PeAF. Further evaluation is needed to provide an electrogram-based method for mapping guided targeted ablation of key areas.

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Data Availability

The Data will not be made available. Any inquires regarding the data can be submitted to the corresponding author and it will be addressed accordingly.

Abbreviations

AF:

Atrial fibrillation

CA:

Catheter ablation

CL:

Cycle length

CLR :

Cycle length of the most recurrent morphology

DF:

Dominant frequency

EMR:

Electrogram morphology recurrence

LA:

Left atrium

PeAF:

Persistent atrial fibrillation

PVI:

Pulmonary vein isolation

RA:

Right atrium

Rec%:

Frequency of most recurrent morphology

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Funding

This study was funded by grants 1R01HL125881 and 1R41HL127907 from the National Heart, Lung, and Blood Institute, National Institutes of Health. Drs. Mitrani and Goldberger receive funding from the Miami Heart Research Institute.

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Authors and Affiliations

  1. Division of Cardiology, University of Miami, 1120 NW 14th St.Clinical Research Building, 1124, 33161, Miami, FL, USA

    Raul D. Mitrani, Ghaith Zaatari, Harold Rivner, Alex Velasquez, Litsa Lambrakos & Jeffrey J. Goldberger

  2. Department of Biomedical Engineering, University of Miami, Miami, FL, USA

    Jorge Bohorquez

  3. Northwestern University, Evanston, IL, USA

    Jason Ng, Justin Ng & Rishi Arora

Authors
  1. Raul D. Mitrani
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  2. Ghaith Zaatari
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  10. Jeffrey J. Goldberger
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Corresponding author

Correspondence to Jeffrey J. Goldberger.

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Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. The patients were enrolled under an investigational device exemption (IDE) protocol approved by the Food and Drug Administration (FDA), and the University of Miami Institutional Review Board.

Informed consent

All patients provided written informed consent.

Competing interests

Drs. Jason Ng and Jeffrey J. Goldberger are co-inventors of the patent for electrogram morphology recurrence analysis.

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Mitrani, R.D., Zaatari, G., Bohorquez, J. et al. Electrogram morphology recurrence guided catheter ablation for repeat ablation of persistent atrial fibrillation. J Interv Card Electrophysiol 67, 183–191 (2024). https://doi.org/10.1007/s10840-023-01594-w

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