Functional mapping to reveal slow conduction and substrate progression in atrial fibrillation

Figures

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  Figure 1. Procedure workflow. Consecutive electroanatomic maps during SR with triple closed-coupled extrastimuli and AF were acquired. AF, atrial fibrillation; CFAE, complex fractionated atrial electrograms; SR, sinus rhythm.

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  Figure 2. Schematic representation of EGMs after the application of the triple extrastimuli. EGM, electrogram; HSC, hidden slow conduction; SR, sinus rhythm.

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  Figure 3. Left atrium segmentation. The left atrium was divided into six segments: anterior wall (A), septum (S), roof (R), posterior wall (P), left lateral wall (L), and pulmonary veins. LAA, left atrial appendage; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein.

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  Figure 4. Electrogram characteristics of sites with positive (turquoise boxes) and negative (red boxes) responses to triple atrial extrastimuli. Bipolar voltage (A) and EGM duration (B) of the preceding SR and after the third extrastimulus. The middle horizontal line represents the median, the box represents the first and third interquartile range, and the vertical line represents the non-outlier range. EGM, electrogram; HSC, hidden slow conduction; SR, sinus rhythm.

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  Figure 5. Electrogram duration maps. The left panel shows the colour-coded EGM duration map during SR. The right panel shows the evoked response colour-coded EGM duration map. An area of abnormal prolonged EGMs is observed in the anterior region of the left atrium in response to triple atrial extrastimuli. EGM, electrogram; SR, sinus rhythm.

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  Figure 6. Box plots (turquoise boxes) of sites with HSC-EGMs in patients with paroxysmal and persistent AF. The red box plot represents the number of CFAE in patients with persistent AF. The middle horizontal line represents the median, the box represents the first and third interquartile range, and the vertical line represents the non-outlier range. AF, atrial fibrillation; CFAE, complex fractionated atrial electrograms; HSC-EGM, hidden slow conduction electrogram.

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  Figure 7. Hidden slow conduction electrogram reproducibility. This image illustrates the reproducibility of EGM fractionation during functional mapping or AF. Electrograms showing a positive response to short-coupled extrastimuli (HSC-EGMs) in two consecutive maps are shown in (A) and (B) (green dots). (C) and (D) show sites with CFAE (pink dots) in two consecutive maps during AF from the same patient. AF, atrial fibrillation; CFAE, complex fractionated atrial electrograms; EGM, electrogram; HSC, hidden slow conduction; LAA, left atrial appendage; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein.