Key result
PVI is linked to reduced collision frequency and activation dispersion in persistent AF.
Why the study?
The study evaluated the effect of pulmonary vein isolation on the frequency of focal, planar, and colliding wavefronts in persistent AF using the novel RETRO-mapping automated activation mapping algorithm.
Does pulmonary vein isolation alter the frequency of focal, planar, and colliding wavefronts in patients with persistent atrial fibrillation?
Observational (n=10)
Does pulmonary vein isolation alter the frequency of focal, planar, and colliding wavefronts in patients with persistent atrial fibrillation?
The novel RETRO-mapping algorithm demonstrates that pulmonary vein isolation significantly reduces wavefront collision frequency and activation direction dispersion in patients with persistent atrial fibrillation.
PVI may reduce wavefront collisions in persistent AF; hypothesis-generating and requires prospective validation before clinical adoption.
RETRO-mapping was developed to automate activation mapping of atrial fibrillation (AF). We used the algorithm to study the effect of pulmonary vein isolation (PVI) on the frequency of focal, planar, and colliding wavefronts in persistent AF. An AFocusII catheter was placed on the left atrial endocardium to record 3 s of AF at six sites pre and post-PVI in patients undergoing wide circumferential PVI for persistent AF. RETRO-mapping analyzed each segment in 2 ms time windows for evidence of focal, planar, and colliding waveforms and the automated categorizations manually validated. Ten patients were recruited. A total of 360 s of data in 120 segments of 3 s from 60 left atrial locations were analyzed. RETRO-map was highly effective at identifying focal waves and collisions during AF. PVI significantly reduced collision frequency but not focal and planar activation frequency. However, there was a significant reduction in the dispersion of activation directions. Larger studies may help determine factors associated with successful clinical outcome.
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Coyle et al. (2023) conducted an observational in persistent atrial fibrillation (n=10). Pulmonary vein isolation (PVI) vs. Pre-PVI was evaluated on Frequency of focal, planar, and colliding wavefronts. Pulmonary vein isolation significantly reduced collision frequency and dispersion of activation directions, but not focal and planar activation frequency, in 10 patients with persistent AF.
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