Comparing phase and electrographic flow mapping for persistent atrial fibrillation

Abstract

Background: An increasing number of methods are being used to map atrial fibrillation (AF), yet the sensitivity of identifying potential localized AF sources of these novel methods are unclear.Here, we report a comparison of two approaches to map AF based upon (1) electrographic flow mapping and (2) phase mapping in a multicenter registry of patients in whom ablation terminated persistent AF.Methods: Fifty-three consecutive patients with persistent AF in whom ablation terminated AF in an international multicenter registry were enrolled. Electrographic flow mapping (EGF) and phase mapping were applied to the multipolar simultaneous electrograms recorded from a 64-pole basket catheter in the chamber (left vs right atrium) where AF termination occurred. We analyzed if the mapping methods were able to detect localized sources at the AF termination site. We also analyzed global results of mapping AF for each method, patterns of activation of localized sources.Results: Patients were 64.3 ± 9.4 years old and 69.8% were male. EGF and phase mapping identified localized sources at AF termination sites in 81% and 83% of the patients, respectively. Methods were complementary and in only n = 2 (3.7%) neither method identified a source. Globally, EGF identified more localized sources than phase mapping (5.3 ± 2.8 vs 1.8 ± 0.5, P < 0.001), with a higher prevalence of focal (compared to rotational) activation pattern (49% vs 2%, P < 0.01). Conclusions:EGF is a novel vectorial-based AF mapping method, which can detect sites of AF termination, agreeing with, and complementary to, an alternative AF mapping method using phase analysis. K E Y W O R D Satrial fibrillation, electrographic flow, electrophysiology, mapping, phase

Propagation velocity at atrial fibrillation sources: Go with the flow

“…The index procedure was guided by clinically-indicated Focal Impulse and rotor mapping (FIRM), and EGF analysis was completed retrospectively. EGF mapping identified 40/50 (80%) of sites detected by FIRM, in agreement with other recent studies [5]. Intuitively, the authors found that sources with the highest temporal stability also had the lowest spatial variability.…”

Functional electrographic flow patterns in patients with persistent atrial fibrillation predict outcome of catheter ablation

“…EGF mapping is a novel method of visualizing cardiac action potential flow and the details of this method have previously been published. 15 , 16 , 17 The ability to visualize action potential flow enables the identification and characterization of functional mechanisms of AF such as active sources that serve as drivers and/or triggers of AF. In many persistent AF patients, spontaneously active sources with focal or reentrant mechanisms repeatedly originate electrical excitations at defined locations in the atrial wall, which flow into the otherwise chaotic excitation waves of fibrillation.…”

Mapping Technologies for Catheter Ablation of Atrial Fibrillation Beyond Pulmonary Vein Isolation

“…These data show some agreement on target sites between phase mapping and other methods as electrographic flow mapping or a method that reconstructs AF signals using sinusoids in an attempt not to detect false rotational activations. [ 84 , 85 ] However, to the best of our knowledge, actual validation in experimental settings using optical mapping comparisons of the current wide range of methodologies has not been performed.…”