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Distributions and number of drivers on real-time phase mapping associated with successful atrial fibrillation termination during catheter ablation for non-paroxysmal atrial fibrillation

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Abstract

Background

Real-time phase mapping (ExTRa™) is useful in determining the strategy of catheter ablation for non-paroxysmal atrial fibrillation (AF). This study aimed to investigate the features of drivers of AF associated with its termination during ablation.

Methods

Thirty-six patients who underwent catheter ablation for non-paroxysmal AF using online real-time phase mapping (ExTRa™) were enrolled. A significant AF driver was defined as an area with a non-passively activated ratio of ≥ 50% on mapping analysis in the left atrium (LA). All drivers were simultaneously evaluated using a low-voltage area, complex fractionated atrial electrogram (CFAE), and rotational activity by unipolar electrogram analysis. The electrical characteristics of drivers were compared between patients with and without AF termination during the procedure.

Results

Twelve patients achieved AF termination during the procedure. The total number of drivers detected on the mapping was significantly lower (4.4 ± 1.6 vs. 7.4 ± 3.8, p = 0.007), and the drivers were more concentrated in limited LA regions (2.8 ± 0.9 vs. 3.9 ± 1.4, p = 0.009) in the termination group than in the non-termination group. The presence of drivers 2–6 with limited (≤ 3) LA regions showed a tenfold increase in the likelihood of AF termination, with 83% specificity and 67% sensitivity. Among 231 AF drivers, the drivers related to termination exhibited a greater overlap of CFAE (56.8 ± 34.1% vs. 39.5 ± 30.4%, p = 0.004) than the non-related drivers. The termination group showed a trend toward a lower recurrence rate after ablation (p = 0.163).

Conclusions

Rotors responsible for AF maintenance may be characterized in cases with concentrated regions and fewer drivers on mapping.

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Data Availability

The datasets generated and/or analyzed during the current study are not publicly available due to ethical principles but are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan

    Shuro Riku, Yasuya Inden, Satoshi Yanagisawa, Aya Fujii, Toshiro Tomomatsu, Toshifumi Nakagomi, Masafumi Shimojo, Takashi Okajima, Koichi Furui, Kazumasa Suga, Susumu Suzuki, Rei Shibata & Toyoaki Murohara

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  1. Shuro Riku
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  2. Yasuya Inden
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  3. Satoshi Yanagisawa
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Correspondence to Satoshi Yanagisawa.

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This study was approved by local institutional ethics committee of the Nagoya University Hospital. All patients provided written informed consent before the procedure.

Conflict of interest

Drs. Yanagisawa and Shibata are affiliated with a department sponsored by Medtronic Japan. The other authors have no conflicts of interest to declare.

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Riku, S., Inden, Y., Yanagisawa, S. et al. Distributions and number of drivers on real-time phase mapping associated with successful atrial fibrillation termination during catheter ablation for non-paroxysmal atrial fibrillation. J Interv Card Electrophysiol 67, 303–317 (2024). https://doi.org/10.1007/s10840-023-01588-8

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