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Organized Sources Are Spatially Conserved in Recurrent Compared to Pre‐Ablation Atrial Fibrillation: Further Evidence for Non‐Random Electrical Substrates
Author(s) -
LALANI GAUTAM G.,
COYSH THOMAS,
BAYKANER TINA,
ZAMAN JUNAID,
HOPPER KENNETH,
SCHRICKER AMIR A.,
TRIKHA RISHI,
CLOPTON PAUL,
KRUMMEN DAVID E.,
NARAYAN SANJIV M.
Publication year - 2016
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12964
Subject(s) - medicine , atrial fibrillation , ablation , cardiology , pulmonary vein , catheter ablation
Conserved Rotors in Recurrent AF Introduction Recurrent atrial fibrillation (AF) after ablation is associated with reconnection of initially isolated pulmonary vein (PV) trigger sites. Substrates are often targeted in addition to PVI, but it is unclear how substrates progress over time. We studied if substrates in recurrent AF are conserved or have developed de novo from pre‐ablation AF. Methods and Results Of 137 patients undergoing Focal Impulse and Rotor Mapping (FIRM) at their index procedure for AF, 29 consecutive patients (60 ± 8 years, 79% persistent) recurred and were also mapped at repeat procedure (21 ± 20 months later) using carefully placed 64‐pole baskets and RhythmView TM (Topera, Menlo Park, CA, USA) to identify AF sources and disorganized zones. Compared to index AF, recurrent AF had a longer cycle length (177 ± 21 vs. 167 ± 19 milliseconds, P = 0.01). All patients (100%) had 1 or more conserved AF rotors between procedures with surrounding disorganization. The number of sources was similar for recurrent AF post‐PVI versus index AF (3.2 ± 1.4 vs. 3.1 ± 1.0, P = 0.79), but was lower for recurrent AF after FIRM+PVI versus index AF (4.4 ± 1.4 vs. 2.9 ± 1.7, P = 0.03). Overall, 81% (61/75) of AF sources lay in conserved regions, while 19% (14/75) were detected de novo . Conclusion Electrical propagation patterns for recurrent AF after unsuccessful ablation are similar in individual patients to their index AF. These data support temporospatial stability of AF substrates over 1–2 years. Trials should determine the relative benefit of adding substrate mapping and ablation to PVI for recurrent AF.