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CA-529-02 PROSPECTIVE EVALUATION OF THE WAVE DYNAMICS USING HIGH DENSITY VECTOR FIELD MAPPING FOR PERSISTENT ATRIAL FIBRILLATION TO DETECT THE ARRHYTHMOGENIC SOURCES

      Background

      We used a novel vector field (VF) mapping to illustrate the stationary wavefront propagating during AF. This approach recomposed regional bipolar fibrillatory electrograms to compute the global propagation patterns of AF.

      Objective

      The effectiveness of utilizing the AVF mapping to identify the AF sources in persistent AF was demonstrated.

      Methods

      In phase 1 study, we applied a cellular automation technique to simulate the electrical wave propagation. The spatial and temporal changes of the similarity index (SI) vector filed around and within the metastable rotors were characterized, and then we determined the thresholds for the SI vector (Figure 1). In Phase 2 study, we enrolled 60 pts with persistent AF prospectively, the global VF map was reconstructed by regional sequential map using multielectrode PentaRay catheter (Carto 3, 20 electrodes, 1000 sites per chamber). The AF cases could be categorized into 2 functional patterns according to the stable location of the drivers. The type I showed the dominant AF drivers emanating from 1 or more PVs. In Type II, drivers were in stable location in the LA with passive activation to PVs. Then, circumferential PVI was successfully performed in all cases and response of PVI was assessed (Figure 2).

      Results

      In phase I study, SI vector was the 0.44±0.13vs 0.13±0.09, (P=0.02), with cut off threshold of 0.4 (AUC=80%) in prediction of AF drivers. In phase II, in total 60 patients analyzed, 184 AF drivers were identified (27.3±19.5 cm2 per patient, with 49% located in the PV/antra region). 36 patients (60%) of type I pts had an average 2.2±1.1 drivers inside PV and 1.8±0.4 drivers outside PV in the LA. 24 patients of type II pts had 0 divers inside PV (P=0.02) and 1.7±0.73 drivers outside PV (P=0.24, compared to type I). In type I, 14 patients (36%) have procedural termination at the AF driver region, and 16 (47%) patients had PV triggers and 12 (27%) non-PV triggers identified in the LA region during sinus rhythm. No patient of type II responded PVI by procedural termination (0%, P=0.02, compared with type I).