Electrographic flow–guided ablation in redo patients with persistent atrial fibrillation (FLOW-AF): design and rationale

Szili-Török, T.; Neužil, Petr; Langbein, Anke; Petrů, Jan; Funasako, Moritoshi; Dinshaw, Leon; Wijchers, Sip; Bhagwandien, Rohit; Rillig, Andreas; Spitzer, Stefan G.; Metzner, Andreas; Kong, Melissa H.; Reddy, Vivek Y.

doi:10.1016/j.hroo.2023.04.001

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…43 The results from the completed randomized controlled clinical trial, FLOW-AF (NCT 04473963) that was designed to evaluate the effectiveness of EGF mapping for AF source detection and for targeting ablation therapy in persistent and long-standing persistent AF patients were recently presented and showed that EGF mapping and ablation resulted in successful elimination of sources in 95% of patients randomized to source ablation and that PVI with adjunctive EGF-guided source ablation improved AF free survival by 51% on an absolute basis at 1 year compared with PVI-only. 44,45…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Time-Dependent Behaviors of Atrial Fibrillation with Electrographic Flow Mapping

Haines,

Kong,

Ruppersberg

et al. 2024

Preprint

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Background Electrographic flow (EGF) mapping algorithms employing Horn-Schunck flow estimations can create temporospatial visualizations of atrial electrical wavefront propagations during atrial fibrillation (AF). Reproducible patterns of centrifugal EGF activation from discrete sites may represent sites of AF origin or sources. Our objectives were to assess the patterns and prevalence of AF sources using EGF mapping. Methods Unipolar electrograms were recorded for 1-minute with 64-pole basket catheters. Flow estimates were constructed by passing consecutive frames through an algorithm to learn and then compare typical wave direction patterns to describe flow-field evolution. During each 2-second segment, sites initiating centrifugal activation patterns were defined as AF sources. Maps of source location/activity duration were generated. Results The EGF method was applied to 405 prospective and retrospective patients with persistent or long-standing persistent AF. Mean age 62.5 years; mean LA size 54 mm; mean AF duration 4.6 years. EGF mapping found 6.6 ± 2.4 AF sources/patient (range 1 to 17). Distribution was 55% LA and 45% RA. Dominant sources (prevalence >20%) were demonstrated in 185 (45.7%) patients, but only 10.7% of all sources were dominant. While AF cycle length (CL) was not affected by source prevalence, CL variance significantly decreased as source prevalence increased. Conclusions Complex AF conduction patterns make ablation challenging, but EGF mapping enables detection and organization of time-dependent AF behaviors. Although many low prevalence sources are detected, they may not be clinically relevant, while higher prevalence sources seem to modulate AF. Recording durations of 1 minute facilitate source discrimination.

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Section: Discussionmentioning

confidence: 99%

Analysis of the Time-Dependent Behaviors of Atrial Fibrillation with Electrographic Flow Mapping

Haines,

Kong,

Ruppersberg

et al. 2024

Preprint

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“…The recently completed randomized controlled FLOW-AF study (NCT 04473963) was designed to assess the safety and feasibility of EGF mapping in patients with non-paroxysmal AF of duration <36 months (see Supplementary material online , Figure S1 ). 18 The present analysis includes the first 23 consecutive patients enrolled at a single centre between September 2019 and October 2020 and a total of 18 de novo patients who had never previously undergone catheter ablation for AF. FLOW-AF was approved by the Homolka Hospital Ethical Committee and Czech Regulatory Authority.…”

Section: Methodsmentioning

confidence: 99%

“…As described in the FLOW-AF Rationale & Design publication , a subset of patients in the FLOW-AF protocol were de novo persistent AF patients, never having previously undergone pulmonary vein isolation (PVI). 18 …”

Section: Methodsmentioning

confidence: 99%

Electrographic flow mapping of persistent atrial fibrillation: intra- and inter-procedure reproducibility in the absence of ‘ground truth’

Reddy,

Kong,

Petru

et al. 2023

Europace

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Aims Validating mapping systems that identify atrial fibrillation (AF) sources (focal/rotational activity) is confounded by the absence of ground truth. A key concern of prior mapping technologies is spatiotemporal instability, manifesting as poor map reproducibility. Electrographic flow (EGF) employs a novel algorithm that visualizes atrial electrical wavefront propagation to identify putative AF sources. We analysed both intra- (3 min) and inter- (>3 months) procedure EGF map reproducibility. Methods and results In 23 persistent AF patients, after pulmonary vein isolation (PVI), EGF maps were generated from 3 serial 1 min recordings using a 64-electrode basket mapping catheter (triplets) at right and left atrial locations. Source prevalence from map triplets was compared between recordings. Per protocol, 12 patients returned for 3-month remapping (1 non-inducible): index procedure post-PVI EGF maps were compared with initial EGF remapping at 3-month redo. Intra-procedure reproducibility: analysing 224 map triplets (111 right atrium, 113 left atrium) revealed a high degree of map consistency with minimal min-to-min shifts: 97 triplets (43%), exact match of leading sources on all 3 maps; 95 triplets (42%), leading source within 1 electrode space on 2 of 3 maps; and 32 triplets (14%), chaotic leading source pattern. Average deviation in source prevalence over 60 s was low (6.4%). Inter-procedure reproducibility: spatiotemporal stability of EGF mapping >3 months was seen in 16 of 18 (89%) sources mapped in 12 patients with (re)inducible AF. Conclusion Electrographic flow mapping generates reproducible intra- and inter-procedural maps, providing rationale for randomized clinical trials targeting these putative AF sources.

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A Randomized Trial of Electrographic Flow-Guided Redo Ablation for Nonparoxysmal Atrial Fibrillation (FLOW-AF)

Reddy,

Langbein,

Petru

et al. 2024

JACC: Clinical Electrophysiology

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Electrographic flow–guided ablation in redo patients with persistent atrial fibrillation (FLOW-AF): design and rationale

Cited by 4 publications

References 23 publications

Analysis of the Time-Dependent Behaviors of Atrial Fibrillation with Electrographic Flow Mapping

Analysis of the Time-Dependent Behaviors of Atrial Fibrillation with Electrographic Flow Mapping

Electrographic flow mapping of persistent atrial fibrillation: intra- and inter-procedure reproducibility in the absence of ‘ground truth’

A Randomized Trial of Electrographic Flow-Guided Redo Ablation for Nonparoxysmal Atrial Fibrillation (FLOW-AF)

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