Noninvasive Imaging of High-Frequency Drivers and Reconstruction of Global Dominant Frequency Maps in Patients With Paroxysmal and Persistent Atrial Fibrillation

OBJECTIVE: Highest dominant-frequency (DF) drivers maintaining atrial fibrillation (AF) activities are effective ablation targets for restoring sinus rhythms in patients. This study aims to investigate whether AF drivers with highest activation rate can be noninvasively localized by means of a frequency-based cardiac electrical imaging (CEI) technique, which may aid in the planning of ablation strategy and the investigation of the underlying mechanisms of AF. METHOD: A total of seven out of 13 patients were recorded with spontaneous paroxysmal or persistent AF and analyzed. The biatrial DF maps were reconstructed by coupling 5-s BSPM with CT-determined patient geometry. The CEI results were compared with ablation sites and DFs found from BSPMs. RESULTS: CEI imaged left-to-right maximal frequency gradient (7.42 ± 0.66 Hz versus 5.85 ± 1.2 Hz, LA versus RA, p < 0.05) in paroxysmal AF patients. Patients with persistent AF were imaged with a loss of the intrachamber frequency gradient and a dispersion of the fast sources in both chambers. CEI was able to capture the AF behaviors, which were characterized by short-term stability, dynamic transition, and spatial repetition of the highest DF sites. The imaged highest DF sites were consistent with ablation sites in patients studied. CONCLUSIONS: The frequency-based CEI allows localization of AF drivers with highest DF and characterization of the spatiotemporal frequency behaviors, suggesting the possibility for individualizing treatment strategy and advancing understanding of the underlying AF mechanisms. SIGNIFICANCE: The establishment of noninvasive imaging techniques localizing AF drivers would facilitate management of this significant cardiac arrhythmia.