Ablation guided by STAR‐mapping in addition to pulmonary vein isolation is superior to pulmonary vein isolation alone or in combination with CFAE/linear ablation for persistent AF

Figures

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  Figure 1. Demonstrates the principles of the STAR mapping method. (A) Shows electrodes (small circles) paired within a pre‐defined geodesic distance (highlighted by the dashed circles). The color of the circles represents the proportion of time an electrode is leading in comparison with the electrodes it is paired with. In this illustration the darker the color the greater proportion of time the electrode is leading. The arrows demonstrate the direction of the wavefront propagation. Electrode 1 is leading its pairs (Electrodes 2, 3, and 4) and Electrode 6 is leading its pairs (Electrode 5, 7, and 8). (B) Shows two wavefront trajectories. In one wavefront trajectory the wavefront propagates from Electrode e1 to e2 and then e3. In the other wavefront trajectory the wavefront propagates from Electrode e1 to e4 and then e3. The STAR mapping method excludes the wavefront trajectory of e2 to e4 as the activation time difference between these two electrodes falls below the plausible activation time difference defined by CV and the geodesic distance between the two electrodes. CV, conduction velocity; STAR, Stochastic Trajectory Analysis of Ranked signals

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  Figure 2. A flow diagram that breaks down how the propensity matched cohort was established in this study. AF, atrial fibrillation; CFAE, complex fractionated electrograms; PVI, pulmonary vein isolation; STAR, Stochastic Trajectory Analysis of Ranked signals

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  Figure 3. Demonstrates Kaplan–Meier curves that compares survival free from AF/AT during follow‐up in the STAR mapping cohort and that achieved in the conventional ablation cohort and PVI alone ablation cohort. The survival free rates were significantly higher in the STAR mapping cohort than the two other cohorts. A majority of the patients with arrhythmia recurrence presented at 3 months follow‐up. AF, atrial fibrillation; AT, atrial tachycardia; PVI, pulmonary vein isolation; STAR, Stochastic Trajectory Analysis of Ranked signals