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Pulmonary vein isolation (PVI) is the cornerstone for atrial fibrillation (AF) treatment; however, its efficacy for persistent AF remains suboptimal. Electrographic Flow (EGF) mapping visualizes near real-time cardiac action potential flow to identify extra-PV sources and flow directionality over time.
Analyze effect of PVI on extra-PV AF source activity (SAC), AF cycle length (CL) and stability of flow angle variability (FAV).
Pre-PVI, unipolar electrograms were recorded for 1 min from a 64-pole basket to generate EGF maps. Relevant AF sources are identified as reproducible patterns of centrifugal EGF activation with prevalence of SAC >20% calculated over 60 sec. EGF pattern determines whether flow directionality remains stable over time or shows high FAV, measuring by how many degrees mean flow vector angle changes. Post-PVI EGF maps recorded once PVI confirmed.
Prospective study of 14 patients undergoing de novo PVI, mean age 63.9±9.0 years, mean LA size 42.9±4.7 mm, mean AF duration 25.9±29.6 months. Pre-PVI, 44.7% (21/47) of sources in LA; 55.3% (26/47) in RA. Of sources remaining post-PVI, 52.1% (25/48) sources were in LA; 47.9% (23/48) in RA. In LA, PVI resulted in 5.0% increase in SAC (p=0.003), 6.9 ms increase in AF CL (p=<0.001), and 0.28° decrease in FAV (p=<0.001). In RA, PVI resulted in 5.5% increase in SAC (p=0.004), 7.4 ms increase in AF CL (p=<0.001), and 0.23° decrease in FAV (p=0.028).
Elimination of electrical conduction from PV triggers results in increased extra-PV SAC; slowing AF CL and stabilization of FAV. PVI may unmask extra-PV AF drivers and stepwise elimination of drivers starting with PV triggers followed by extra-PV sources simplifies AF conduction patterns.