Electrocardiographic Imaging of Atrial Fibrillation Detects Sites of Acute Termination After Rotor Ablation

Miguel Rodrigo1, Andreu M. Climent2, Ismael Hernandez-Romero3, Tina Baykaner4, Wouter-Jan Rappel4, Maria S Guillem5, Felipe Atienza3, Sanjiv M Narayan4
1Universitat Politècnica de València, 2Hospital Gregorio Marañón, 3Hospital GU Gregorio Marañón, IiSGM, CIBERCV, Spain, 4Cardiovascular Institute, Stanford University, USA, 5ITACA Institute, Universitat Politècnica de València, Spain


Abstract

Ablation of atrial fibrillation (AF) has been proven an effective therapy for drug refractory AF patients. Intracardiac mapping and non-invasive electrocardiographic imaging (ECGI) may identify AF drivers with different properties, yet they have not been compared in the same patients. In this abstract we present 4 cases highlighting the potential complementation between re-entrant driver location from simultaneous prospective endocardial and non-invasive recordings. Intracardiac electrograms of 4 patients in which localized ablation terminated AF (3 persistent, 68±11 years, 3 male) were recorded simultaneously with a 64-pole basket catheter and 52-lead body surface recordings. Rotational sources detected by activation+phase (FIRM) analysis was used to prospectively guide the ablation procedure. ECGI signals were reconstructed by using zero-order Tikhonov regularization and reentrant sources were identified by phase analysis. Endocardial analysis revealed 8±3 reentrant sources with baskets covering 71±11% of the atrial endocardial wall (< 1 cm from an electrode). Localized ablation was conducted in 5±2 sources and in all 4 patients the ablation of one of such sources terminated AF to either sinus rhythm (3 cases) or atrial tachycardia (1 case). ECGI analysis identified all these termination sources (100%) with a spatial error of 13±4 mm. Of the total amount of reentrant sources, 6±2 (73±10%) were identified with ECGI with a spatial error of 19±9 mm. AF rotational sources can be detected both endocardial and non-invasively, at least with moderate spatial concordance. Non-invasive mapping can complement basket recordings helping to identify AF sources in anatomies hard to be mapped.