High-density evaluation of the arrhythmogenic substrate in persistent atrial fibrillation

Figures

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  Figure 1. Comparative analysis of EGM mapping modalities during different rhythm conditions. A: Comparisons between bipolar and OT recordings during CSP. B: Similar comparisons during AF. All data points are included, before excluding outliers as per the exclusion criteria described in the Methods. C: Comparisons between the same EGM recordings across different rhythms: CSP-bipolar vs AF-bipolar. Similarly, panel D compares CSP-OT with AF-OT recordings. AF = atrial fibrillation; CSP = coronary sinus pacing; EGM = electrogram; OT = omnipolar technology.

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  Figure 2. Comparative analysis of peak-to-peak voltage recordings and GPMI method maps. A: Posterior and anterior wall views of peak-to-peak voltage recordings from bipolar and OT maps CSP. B: Pointwise maps of peak-to-peak voltage recordings interpolated using the GPMI method. C and D: Voltage mapping during AF with peak-to-peak voltage recordings (C) and GPMI interpolation (D). E and F: CV maps of the LA during CSP, with BiV (E) and OT (F). AF = atrial fibrillation; Ant = anterior; BiV = bipolar voltage; CSP = coronary sinus pacing; CV = conduction velocity; GPMI = Gaussian process manifold interpolation; OT = omnipolar technology; Post = posterior.

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  Figure 3. Pointwise comparison of bipolar and OT during CSP and AF. The colors represent correlation values, with red indicating peak-to-peak voltage measurements and blue representing the GPMI method. (A) Correlation between CSP-bipolar and CSP-OT recordings. (B) Correlation between AF-bipolar and AF-OT recordings. (C) Correlation between CSP-bipolar and AF-bipolar recordings. (D) Correlation between CSP-OT and AF-OT recordings. AF = atrial fibrillation; CSP = coronary sinus pacing; GPMI = Gaussian process manifold interpolation; OT = omnipolar technology.

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  Figure 4. Regional segmentation of the left atrium (LA). The LA was segmented into 14 predefined regions, including the 4 pulmonary veins, the mitral valve (MV) region, the coronary sinus (CS) region, the LAA, the anterior and posterior walls (further divided into superior and inferior portions), the lateral wall, the roof, the inferior region, and the septum. A shows the anterior view, B shows the posterior view, and D displays the 2D view. 2D = 2-dimensional; LAA = left atrial appendage; LIPV = left inferior pulmonary vein; RSPV = right superior pulmonary vein.

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  Figure 5. Regional analysis of the relationship between bipolar and OT recordings during CSP and AF. Each plot presents the results of linear regression analysis comparing the mean voltage in specific anatomic regions of the LA across 14 predefined regions for each modality. A: Linear regression of CSP-OT vs CSP-bipolar recordings. B: Linear regression of AF-OT vs AF-bipolar recordings. C: Linear regression of AF-bipolar vs CSP-bipolar recordings. D: Linear regression of AF-OT vs CSP-OT recordings. AF = atrial fibrillation; CSP = coronary sinus pacing; LA =left atrium; OT = omnipolar technology.

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  Figure 6. ROC curves illustrate the identification of low-voltage areas (LVAs) for each rhythm and bipolar threshold. A: Each line represents the sensitivity and specificity across varying OT thresholds, based on 4 distinct BiV thresholds reported in the literature for CSP and AF. The median optimal OT threshold, calculated across all patients for each bipolar threshold, is provided. B: Relationship between bipolar and OT voltage thresholds in CSP (blue) and AF (red). The OT threshold with the highest concordance to the bipolar map is shown for various bipolar thresholds across individual patients (blue stars and red dots represent CSP and AF, respectively). Means are indicated as continuous lines, and standard deviations are indicated by error bars. The optimal OT threshold is determined as the point on the ROC curve corresponding to each bipolar threshold across all patients. Linear regression lines are depicted (dotted), with Pearson correlation coefficients (r) provided for CSP and AF. AF = atrial fibrillation; AUC = area under the curve; BiV = bipolar voltage; CSP = coronary sinus pacing; OT = omnipolar technology; ROC = receiver operating characteristic; Sen = sensitivity; Sep =…