The spatiotemporal electrogram dispersion ablation targeting rotors is more effective for elderly patients than non‐elderly population

Figures

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  FIGURE 1. Study protocol. (A) The STED within the entire left and right atria during atrial fibrillation was tagged and ablated. If atrial fibrillation remained unchanged, we applied electrical cardioversion and tested the non‐inducibility before the procedure ended. (B) Identification of STED using a PentaRay catheter. (C) Identification of GP points by HFS and a GP ablation plus antral pulmonary vein isolation. GP, ganglionated plexi; HFS, high‐frequency stimulation; PVI, pulmonary vein isolation; STED, spatiotemporal electrogram dispersion.

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  FIGURE 2. Features of STED areas. (A) Simultaneous mapping of the STED, CFAEs, and LVAs during atrial fibrillation. (B) Ratio of the STED areas, CFAE areas, and LVAs within the entire LA (blue frame: STED area, waveform: CFAE area, dotted‐square: LVA, and filled‐gray: both non‐CFAE areas and non‐LVAs). Ratio of STED areas in CFAE areas (37%) versus in non‐CFAE areas (13%) (p = .010); and the ratio of STED areas in LVAs (9%) versus in non‐LVAs (25%) (p = .033). (C) Relationship of the STED areas to CFAE areas and LVAs (blue frame: STED area, filled‐pink: both CFAE area and LVA, waveform: both CFAE area and non‐LVA, dotted‐square: both LVA and non‐CFAE area, and filled‐gray: both non‐CFAE area and non‐LVA). CFAE, complex fractionated atrial electrogram; LA, left atrium; LVA, low‐voltage‐area; STED, spatiotemporal electrogram dispersion.

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  FIGURE 3. Distribution of STED areas. Distribution of the STED (anterior wall, posterior wall, atrial septum, posterolateral, roof, inferior, PV‐LA appendage ridge, LA appendage, left PV, and right PV). LA, left atrium; PV, pulmonary vein; STED, spatiotemporal electrogram dispersion.

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  FIGURE 4. Acute and long‐term outcomes in the STED strategy. (A) Change in AF during the STED ablation. (B) Non‐inducibility after the STED ablation. (C) The black lines indicate the freedom from atrial arrhythmias in the STED strategy (thick line: ATA, thin line: AF, and normal line: AT). (D) The red and black lines indicate the freedom from atrial arrhythmias in the STED strategy with an acute AF termination and the STED strategy with no change of AF (thick line: ATA, thin line: AF, and normal line: AT). (E) Adjusted survival curves after the STED ablation. The red and black lines indicate the freedom from ATAs in patients above and below 70 years, respectively. AF, atrial fibrillation; AT, atrial tachycardia; ATA, atrial tachyarrhythmias; LA, left atrial; STED, spatiotemporal electrogram dispersion; Y, years old.

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  FIGURE 5. Acute and long‐term outcomes in the conventional strategy and a comparison between the strategies. (A) Change in the AF in the conventional strategy. (B) Non‐inducibility in the conventional strategy. (C) Comparison between the strategies. The red and black lines indicate the freedom from atrial arrhythmias in the matched‐STED group and matched‐GPPVI group patients (thick line: ATA, thin line: AF, and normal line: AT). AF, atrial fibrillation; AT, atrial tachycardia; ATA, atrial tachyarrhythmias; GPPVI, ganglionated plexi ablation plus antral pulmonary vein isolation; STED, spatiotemporal electrogram dispersion.