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.

You do not currently have access to this article.