Key result
An algorithm based on P-wave morphology and intra-atrial multipolar activation pattern and timing identified the site of origin for 72% of paced and 70% of spontaneous non-PV trigger sites.
Why the study?
Nonpulmonary vein triggers of AF are targets for ablation, but their localization remains clinically challenging.
Does an algorithm based on P-wave morphology and intra-atrial multipolar activation pattern and timing accurately localize non-PV trigger sites of atrial fibrillation?
Observational (n=108)
Blinded observers
Does an algorithm based on P-wave morphology and intra-atrial multipolar activation pattern and timing accurately localize non-PV trigger sites of atrial fibrillation?
An algorithm combining P-wave morphology and intra-atrial multipolar activation patterns can successfully localize non-pulmonary vein triggers of atrial fibrillation in approximately 70% of cases.
May aid non-PV trigger localization in AF ablation; leaves open need for prospective validation before clinical adoption.
INTRODUCTION: Nonpulmonary vein (non-PV) triggers of atrial fibrillation (AF) are targets for ablation but their localization remains challenging. The aim of this study was to describe P-wave (PW) morphologic characteristics and intra-atrial activation patterns and timing from multipolar coronary sinus (CS) and crista terminalis (CT) catheters that localize non-PV triggers. METHODS AND RESULTS: Selective pacing from six right and nine left atrial common non-PV trigger sites was performed in 30 consecutive patients. We analyzed 12 lead ECG features based on PW duration, amplitude and morphology, and patterns and timing of multipolar activation for all 15 sites. Regionalization and then precise localization required criteria present in at least 70% of assessments at each pacing site. The algorithm was then prospectively evaluated by four blinded observers in a validation cohort of 18 consecutive patients undergoing the same pacing protocol and 60 consecutive patients who underwent successful non-PV trigger ablation. The algorithm for site regionalization included 1) negative PW in V1, ≥30 µV change in PW amplitude across the leads V1-V3, and PW duration ≤100 milliseconds in lead 2 and 2) unique intra-atrial activation patterns and timing noted in the multipolar catheters. Specific ECG and intra-atrial activation timing characteristics included in the algorithm allowed for more precise site localization after regionalization. In the prospective evaluation, the algorithm identified the site of origin for 72% of paced and 70% of spontaneous non-PV trigger sites. CONCLUSION: An algorithm based on PW morphology and intra-atrial multipolar activation pattern and timing can help identify non-PV trigger sites of origin.
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Kubala et al. (2019) conducted an observational in Atrial fibrillation with nonpulmonary vein triggers (n=108). Algorithm based on P-wave morphology and intra-atrial multipolar activation was evaluated on Identification of the site of origin for paced and spontaneous non-PV trigger sites. An algorithm based on P-wave morphology and intra-atrial multipolar activation pattern and timing identified the site of origin for 72% of paced and 70% of spontaneous non-PV trigger sites.
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