Electrographic Flow Mapping Provides Prognosis for AF Ablation Outcomes Across Two Independent Prospective Patient Cohorts

Figures

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  Figure 1. Twelve-month FFAF rates based on EGFC categorization. Patients with healthier substrate (EGFC > 0.62) demonstrated better outcomes (p = 0.005) in a consistent pattern across both FLOW-AF and the AF-FLOW Global Registry.

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  Figure 2. Mean EGFC and outcomes by atrium across all patients in FLOW-AF and the AF-FLOW Global Registry. FFAF patients are depicted in blue; recurrence patients are depicted in red. The horizontal dashed line indicates the population mean RA EGFC; the vertical dashed line indicates the population mean LA mean EGFC. A linear relationship was established between RA and LA EGFC means (m = 0.51, r = 0.42, p < 0.001). Slope and r were unaffected by recurrence status of patients.

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  Figure 3. Four phenotypes were characterized based on the presence or absence of EGF-identified sources coupled with the presence of high or low EGFC. Active sources appear as yellow-red spots on summary maps and often localize to focal regions of divergent flow (yellow) on segment maps. EGFC is visualized as high-magnitude flow in a consistent direction over time, so regions with high EGFC are seen as vectors of longer length on summary maps and as purple regions on segment maps. Shorter vectors and more blue regions are areas of disorganized flow with low EGFC.

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  Figure 4. Twelve-month FFAF rates by phenotype across both trials. Trends from the AF-FLOW Global Registry help to validate those initially reported in FLOW-AF with improved Type II and Type III outcomes in the AF-FLOW Global Registry buoyed by the higher rate of EGF-guided source ablation among AF-FLOW Global Registry patients.

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  Figure 5. Twelve-month FFAF by patient type and treatment modality. Patients who received extra-PV ablation of EGF-identified sources showed higher rates of FFAF across both trials (p = 0.026), bringing FFAF to similar levels observed in patients without sources. Trends in improved outcomes due to source ablation in the AF-FLOW Global Registry align with those of FLOW-AF.