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Usage of a new mapping algorithm to detect possible critical substrate for continuity of atrial fibrillation: fractionation mapping in preliminary experience

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Abstract

Although treatment of atrial fibrillation (AF) classically focuses on eliminating the pulmonary vein (PV) triggers, isolation of PVs is associated with limited success rates in patients with persistent AF. The role of the left atrial appendage (LAA) as both trigger and driver in arrhythmogenesis of AF was previously demonstrated. In the present case, fractionation mapping software of Ensite system was firstly tested to detect critical substrate during AF. Focusing on the width and continuity of fractionation pattern, the LAA was accepted as main driver for maintenance of AF. Ablation in fractionated electrograms around the LAA caused acute AF termination. After isolation of the LAA, no AF was inducible with atrial stimulation with and without isoproterenol infusion. Fractionation mapping may be used to detect potential importance of the LAA in AF continuity.

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Authors and Affiliations

  1. Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey

    Tolga Aksu, Tumer Erdem Guler & Serdar Bozyel

  2. Department of Cardiology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Kivanc Yalin

Authors
  1. Tolga Aksu
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  2. Tumer Erdem Guler
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  3. Serdar Bozyel
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  4. Kivanc Yalin
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Correspondence to Tolga Aksu.

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Supplemental Fig. 1

Data collection for left atrial fractionation map by using settings in Fig. 1 is shown in LAO projection. Purple areas demonstrate electrograms lower than 4 deflections (JPG 502 kb)

Supplemental Fig. 2

Fractionation map of left atrium and intracardiac electrograms during radiofrequency ablation around the LAA. Ablation is started from fragmented sites around the ostium of left atrial appendage. Translation from atrial fibrillation to atrial flutter after the first radiofrequency lesion is seen in below (JPG 269 kb)

Supplemental Fig. 3

Fractionation map of left atrium and intracardiac electrograms during radiofrequency ablation around the LAA. Sinus rhythm is achieved ablation in progress in the near site. Please compare the tip of ablation catheter with Supplemental Fig. 2 (JPG 256 kb)

Movie 1

Ablation is started from fragmented sites around the ostium of left atrial appendage. Please see translation from atrial fibrillation to atrial flutter after the first radiofrequency lesion (MPG 8492 kb)

Movie 2

The ninth radiofrequency lesion around the ostium of left atrial appendage causes acute AF termination (MPG 10315 kb)

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Aksu, T., Guler, T.E., Bozyel, S. et al. Usage of a new mapping algorithm to detect possible critical substrate for continuity of atrial fibrillation: fractionation mapping in preliminary experience. J Interv Card Electrophysiol 58, 29–34 (2020). https://doi.org/10.1007/s10840-019-00693-x

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  • DOI: https://doi.org/10.1007/s10840-019-00693-x

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