Comparison of phase mapping and electrogram‐based driver mapping for catheter ablation in atrial fibrillation

Lin, Chin Yu; Narayan, Sanjiv M.; Baykaner, Tina; Lo, Men Tzung; Chung, Fa Po; Chen, Yun Yu; Lo, Li Wei; Hu, Yu Feng; Liao, Jo Nan; Tuan, Ta Chuan; Chao, Tze Fan; Chung, Fa‐Po; Kuo, Ling; Chang, Tsan‐Kuo; Salim, Simon; Chien, Kuo Liong; Chen, Shih Ann

doi:10.1111/pace.13573

Cited by 15 publications

(13 citation statements)

References 34 publications

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“…A step towards better understanding of the clinical impact of different AF driver mapping methodologies has recently been performed by Lin et al in patients with PersAF. [ 28 ] Their meta-analysis confirmed that adjunctive driver-guided ablation in addition to PVI could improve one-year AF freedom and increase acute AF termination rate without a significant increase in potential complications. The benefit in PersAF ablation seems to be more evident using phase-mapping methodologies rather than electrogram-based driver mapping.…”

Section: Main Clinical Evidence Using Novel Mapping Methods For Af Abmentioning

confidence: 92%

“…The benefit in PersAF ablation seems to be more evident using phase-mapping methodologies rather than electrogram-based driver mapping. [ 28 ]…”

Section: Main Clinical Evidence Using Novel Mapping Methods For Af Abmentioning

confidence: 99%

“…[ 26 ] Those studies have adapted the Hilbert transformation as a practical way to derive the signal phase from the voltage-time series, and to demonstrate rotational drivers underlying AF maintenance in PxAF, PersAF and long-lasting PersAF. [ 26 – 28 ] In 80% of cases with non-PxAF, the drivers have been identified as rotors, which often colocalised with focal breakthroughs. [ 15 , 16 , 29 ] Since then, several non-invasive (electrocardiographic imaging; ECGI) and invasive (focal impulse and rotor modulation [FIRM] and electrogram similarity/phase-mapping combined techniques) mapping approaches have used phase-mapping to guide driver detection and ablation ( Tables 1 and 2 , Figure 1 ).…”

Section: Experimental Bases and Clinical Tools To Identify Drivers Of Afmentioning

confidence: 99%

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

et al. 2021

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Catheter ablation remains the most effective and relatively minimally invasive therapy for rhythm control in patients with AF. Ablation has consistently shown a reduction of arrhythmia-related symptoms and significant improvement in patients’ quality of life compared with medical treatment. The ablation strategy relies on a well-established anatomical approach of effective pulmonary vein isolation. Additional anatomical targets have been reported with the aim of increasing procedure success in complex substrates. However, larger ablated areas with uncertainty of targeting relevant regions for AF initiation or maintenance are not exempt from the potential risk of complications and pro-arrhythmia. Recent developments in mapping tools and computational methods for advanced signal processing during AF have reported novel strategies to identify atrial regions associated with AF maintenance. These novel tools – although mainly limited to research series – represent a significant step forward towards the understanding of complex patterns of propagation during AF and the potential achievement of patient-tailored AF ablation strategies for the near future.

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Section: Main Clinical Evidence Using Novel Mapping Methods For Af Abmentioning

confidence: 92%

“…The benefit in PersAF ablation seems to be more evident using phase-mapping methodologies rather than electrogram-based driver mapping. [ 28 ]…”

Section: Main Clinical Evidence Using Novel Mapping Methods For Af Abmentioning

confidence: 99%

Section: Experimental Bases and Clinical Tools To Identify Drivers Of Afmentioning

confidence: 99%

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

et al. 2021

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“…The basket contact-mapping catheter has limited resolution, but is sufficient to record organized rotational/focal activity [ 59 , 60 ] and has been shown by others to be superior to prior methods [ 61 ]. It remains unclear which method for detecting AF phase singularities is optimal, but a recent meta-analysis supports the use of phase mapping for AF [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

Three dimensional reconstruction to visualize atrial fibrillation activation patterns on curved atrial geometry

et al. 2021

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Background The rotational activation created by spiral waves may be a mechanism for atrial fibrillation (AF), yet it is unclear how activation patterns obtained from endocardial baskets are influenced by the 3D geometric curvature of the atrium or ‘unfolding’ into 2D maps. We develop algorithms that can visualize spiral waves and their tip locations on curved atrial geometries. We use these algorithms to quantify differences in AF maps and spiral tip locations between 3D basket reconstructions, projection onto 3D anatomical shells and unfolded 2D surfaces. Methods We tested our algorithms in N = 20 patients in whom AF was recorded from 64-pole baskets (Abbott, CA). Phase maps were generated by non-proprietary software to identify the tips of spiral waves, indicated by phase singularities. The number and density of spiral tips were compared in patient-specific 3D shells constructed from the basket, as well as 3D maps from clinical electroanatomic mapping systems and 2D maps. Results Patients (59.4±12.7 yrs, 60% M) showed 1.7±0.8 phase singularities/patient, in whom ablation terminated AF in 11/20 patients (55%). There was no difference in the location of phase singularities, between 3D curved surfaces and 2D unfolded surfaces, with a median correlation coefficient between phase singularity density maps of 0.985 (0.978–0.990). No significant impact was noted by phase singularities location in more curved regions or relative to the basket location (p>0.1). Conclusions AF maps and phase singularities mapped by endocardial baskets are qualitatively and quantitatively similar whether calculated by 3D phase maps on patient-specific curved atrial geometries or in 2D. Phase maps on patient-specific geometries may be easier to interpret relative to critical structures for ablation planning.

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“…Among these substrate modification strategies, driver‐guided ablation has emerged as a potential therapeutic target for ablation of persistent AF. In a pooled meta‐analysis, the driver/rotor identification and ablation approach, despite using different mapping techniques and catheters, was associated with higher rates of acute AF termination (odds ratio [OR]: 4.62, p < .001) and lower rates of recurrence of any atrial arrhythmia (OR: 0.44, p < .001) 16 . We have previously reported that after PVI in patients with persistent AF, atrial substrate modification guided by SI and nonlinear phase mapping is associated with a lower AF recurrence rate compared with those receiving CFAE ablation 7 .…”

Section: Discussionmentioning

confidence: 99%

Optimal substrate modification strategies using catheter ablation in patients with persistent atrial fibrillation: 3‐year follow‐up outcomes

Hsieh

Lin

et al. 2021

Cardiovasc electrophysiol

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Objectives This study aimed to assess the comparative efficacy of four ablation strategies on the incidence rates of freedom from atrial fibrillation (AF) or atrial tachycardia (AT) through a 3‐year follow‐up in patients with persistent AF. Background The optimal substrate modification strategies using catheter ablation for patients with persistent AF remain unclear. Methods Patients with persistent AF were enrolled consecutively to undergo each of four ablation strategies: (a) Group 1 (Gp 1, n = 69), pulmonary vein isolation (PVI) plus rotor ablation assisted by similarity index and phase mapping; (b) Gp 2 (n = 75), PVI plus linear ablations at the left atrium; (c) Gp 3 (n = 42), PVI plus the elimination of complex fractionated atrial electrograms; (d) Gp 4 (n = 67), PVI only. Potential confounders were adjusted via a multivariate survival parametric model. Results Baseline characteristics were similar across the four groups. At a follow‐up period of 34.9 ± 38.6 months, patients in Gp 1 showed the highest rate of freedom from AF compared with the other three groups (p = .002), while patients in Gp 3 and 4 showed lower rates of freedom from AT than those of the other two groups (p = .006). Independent predictors of recurrence of AF were the ablation strategy (p = .002) and left atrial diameter (LAD) (p = .01). Conclusion In patients with persistent AF, a substrate modification strategy using rotor ablation assisted by similarity index and phase mapping provided a benefit for maintaining sinus rhythm compared with the other strategies. Both ablation strategy and baseline LAD predicted the 3‐year outcomes of freedom from AT/AF

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Comparison of phase mapping and electrogram‐based driver mapping for catheter ablation in atrial fibrillation

Cited by 15 publications

References 34 publications

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

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

Three dimensional reconstruction to visualize atrial fibrillation activation patterns on curved atrial geometry

Optimal substrate modification strategies using catheter ablation in patients with persistent atrial fibrillation: 3‐year follow‐up outcomes

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