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Characterization of rotor phenomena with high-density body surface electrode mapping in persistent atrial fibrillation and impact of pulmonary vein isolation
Session:
Comunicações Orais - Sessão 12 - Fibrilhação Auricular: Novas Perspetivas sobre os Mecanismos
Speaker:
Mário Martins Oliveira
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.9 Atrial Fibrillation - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mário Martins Oliveira; Pedro Silva Cunha; Sérgio Laranjo; Guilherme Portugal; Bruno Valente; Ana Lousinha; Barbara Teixeira; Manuel Braz; Josep Boque; Ana Sofia Delgado; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:"Helvetica",sans-serif"><span style="color:black">Rapid rotational activations have been proposed to be implicated in atrial fibrillation (AF) maintenance. CardioInsight (ECGi) high-density body surface electrode mapping of atria has been used to identify atrial rotor activities to guide persistent AF ablation (PersAF). Stability and reproducibility of rotor identification across the atria during AF have not been well-validated. Also, the impact of pulmonary veins isolation (PVI) on the dynamics of rotors remains unknown. We aim to evaluate the spatial pattern of rotors distribution in PersAF patients (P) undergoing PVI. <strong>Methods:</strong> Fourteen P </span></span></span><span style="font-family:"Helvetica",sans-serif"><span style="color:black">(mean age 57,7 years; 78,5% men), who underwent catheter radiofrequency ablation with ECGi mapping, to identify high-yield rotors, projected onto cardiac computed tomography scan per protocol. U<span style="background-color:white">nipolar electrogram files of 10-sec duration were recorded before vascular catheterization (step 1) and repeated after 3D voltage electroanatomic mapping (CARTO system) (step 2), and PVI (step 3). Rotor activities were recognized automatically (phase map analysis) and checked manually. A wave rotating > 2.0 times around a spatially stable core was considered for the present analysis. A biatrial schema (Bordeaux atrial classification) with 7 regions was used: left PV and left atrial appendage (region 1); right PV and posterior interatrial grove (region 2); posterior left atrium (LA) (region 3); upper half of the right atrium (RA) and RA appendage (region 4); lower half of the RA (region 5); anterior LA and roof (zone 6); anterior interatrial grove (region 7). </span><strong><span style="font-family:"Helvetica",sans-serif">Results:</span></strong> A total of 152 rotors were seen in 11P (78,5%). Rotors were most commonly observed in region 2 (mean number of rotors [MNR]: 3,7), followed by zones 1 and 4 (MNR: 2,2; 2,1; respectively) and zones 3, 6 and 7 (MNR: 1,0; 0,8 and 1,6; respectively) (p <0,05, zone 1, 2, 4 vs. zones 3,6,7). Also, zone 2 presented a higher number of rotations around a core (NRC) (mean 11,7), compared to other zones (p<0,01 vs. zone 3,6; p<0,07 vs. zones 1,4,7). Regarding reproducibility, rotors maintained the same atrial location, along steps 1-3 of the procedure. After antral PVI, a significant reduction (>50%) in the number of rotors and number of rotations was observed in all but zones 5 and 6. <strong><span style="font-family:"Helvetica",sans-serif">Conclusions:</span></strong> <span style="background-color:white">ECGi high-density phase mapping of atria identified </span>high-yield stable and reproducible rotors in most PersAF P. Right PV and posterior interatrial grove showed a higher number of rotors, with more rotational activity. Antral PVI may obtain a reduction in rotor activity. Future validation of ECGi technology contribution for understanding mechanistic-based ablation of PersAF is needed.</span></span></span></span></p>
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