Electrographic flow mapping of atrial fibrillation

Figures

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  Box 1. no caption available

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  FIGURE 1. Electrographic flow mapping process. (a–e) 64-pole basket catheters record unipolar EGMs, which are transformed into flow vectors via Green's interpolation and a modified Horn–Schunk algorithm into EGF Segment Maps. EGF, electrographic flow; EGM, electrographic flow mapping.

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  FIGURE 2. Electrographic flow map validation via fluoroscopy in an animal model. (a) In spontaneously persistent atrial fibrillation, an EGF Summary Map (left) and EGF Segment Map (right) reveal a focal source at BC3 that emanates flow (blue star). (b) Pacing above capture threshold with confirmation of local myocardial capture during spontaneously persistent atrial fibrillation results in simulation of a focal source at A2, which is the location of the tip of the pacing catheter (orange star). Note how the flow field changes in terms of location of the origin and directionality of flow. EGF, Electrographic flow.

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  FIGURE 3. FLOW-AF trial results. (a) Schematic of study design. (b) Example EGF Summary Maps recorded from a treatment patient in the left atrial central position preablation and postablation. Source activity (SAC) dropped from 27 to 15% as a result of ablation. (c) Kaplan–Meier survival curves for the two randomized groups of patients possessing sources. There was a 51% absolute reduction in recurrence rates resulting from EGF-guided ablation of the sources. EGF, electrographic flow.

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  FIGURE 4. Four electrographic flow-based phenotypes. Source presence and low EGFC are the largest predictors of recurrence but source ablation mitigates the impact of sources. On EGF Summary Maps (top) and EGF Segment Maps (bottom), sources appear as yellow-red ‘hot spots’. On EGF Segment Maps, high EGFC regions appear as long, magenta vectors whereas low EGFC regions appear as short, blue vectors. EGFC, electrographic flow consistency.