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A.S. Jadidi, J. Chen, H. Lehrmann, B. Mueller-Edenborn, J. Allgeier, R. Weber, D. Trenk, T. Arentz, P3629
Rotational and Focal AF Sources Localize to Low Voltage Areas Displaying Slow Conduction in Sinus Rhythm, European Heart Journal, Volume 38, Issue suppl_1, August 2017, ehx504.P3629, https://doi.org/10.1093/eurheartj/ehx504.P3629 - Share Icon Share
Extract
Introduction: Presence of left atrial (LA) low voltage substrate (LVS) is associated with an increased arrhythmia recurrence after PVI in persistent AF.
Purpose: We compared the anatomical distribution of arrhythmia sources in AF/AT to LVS in sinus rhythm (SR).
Methods: 21 persistent AF patients underwent high-density mapping in AF/AT and SR. Potential rapid focal or rotational sources in AF/AT were annotated on the LA geometry for correlation to the LVS in SR (areas <0.5 mV or fractionated (FP) or late potentials (LP) within transitional zone <1.0mV). After PVI plus ablation of AF&AT-sources and LVS in SR, 1-year clinical FU was assessed.
Results: 15/21 patients presented in SR and were pace-induced to AT. 43 ATs (21 focal, 22 macro-reentries) were found with location of their sources within/bordering LVS in SR. In 3 patients AT converted to AF. The AF termination site displayed continuous activity and co-located to LVS in SR (low voltage 0.31mV with LP/FP, figure). 6/21 patients presented in AF. Potential AF sources were mapped using the 20-pole Spiral-like catheter. A total of 31 potential AF driver sites were annotated on the LA geometries in 9 patients with AF. A pathological substrate in SR (with voltage <1.0mV & FP/LP) was found at 23/31 (74%) identified AF sources. Procedure time was in 167±18 min, RF-time: 27±9 min, X-time: 11±6 min, X-dose: 468±356 uGy*m2. Arrhythmia freedom was achieved in 73% of patients at 12 months.