ECGI targeted ablation for persistent AF not responding to pulmonary vein isolation: Results of a two-staged strategy (TARGET AF2)

Figures

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  Figure 1. Flow chart showing the flow of enrolled patients from the ECGI phenotyping of persistent AF based on driver burden and distribution to predict response to pulmonary vein isolation (PHENOTYPE-AF) study into the electrocardiographic imaging ECGI targeted ablation for persistent AF not responding to pulmonary vein isolation: results of a two-staged strategy (TARGET AF2). PVI = pulmonary vein isolation.

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  Figure 2. This flow chart shows the flow of patients and their outcomes. The patients are grouped as per the arrhythmia that they had documented prior to enrollment into the electrocardiographic imaging (ECGI) TARGET AF2 study. AAD = antiarrhythmic drug; AF = atrial fibrillation; AT = atrial tachycardia; CL = cycle length; PD = potential driver; pts = patients; SR = sinus rhythm.

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  Figure 3. This histogram shows the distribution of the number of cycles per rotational driver.

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  Figure 4. A–C: Histograms of the number of cycles per rotational driver in the left atrium (A), in the right atrium (B), and on the septum (C).

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  Figure 5. Electrocardiographic imaging–guided driver ablation causing organization of atrial fibrillation. A: An electrocardiographic imaging composite map of the atria in an anteroposterior view. The yellow area shows rotational activations, and the orange balls show focal activations at the anterior border of the left atrial appendage (LAA) and at the top of the appendage ridge. B: An end-procedure CARTO map in a similar view. The red balls are visitags that are automated marking of lesions. The right pulmonary veins were reisolated at the start. There is a cluster of lesions on the anterior wall where rotational drivers were detected, then an overlapping cluster of lesions at the border of the left atrial appendage and at the top of the appendage ridge. The green ball is where the cycle length change in panel C occurred. Following organization into an atrial tachycardia, ablation was required on the left atrial roof, and further ablation of a focal tachycardia anterior to the left atrial appendage was required. LSPV = left superior pulmonary vein; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein;