Key Points
- To characterize direction-dependent and coupling interval-dependent left atrial conduction delay and electrogram morphology in paroxysmal atrial fibrillation patients with normal bipolar voltage.
- Performed high-density intracardiac contact mapping during incremental atrial pacing in N=15 consecutive patients with paroxysmal AF undergoing first-time pulmonary vein isolation.
- Evaluated conduction delay, activation dispersion, and electrogram characteristics relative to AF inducibility during electrophysiology study and clinical arrhythmia recurrence over a 2-year follow-up.
- Arrhythmia recurrence during the 2-year follow-up occurred exclusively in patients exhibiting conduction delay at long extrastimulus intervals (high right atrium: 326 ± 13 ms; coronary sinus: 319 ± 16 ms).
- Patients with inducible AF demonstrated significantly greater activation dispersion time than non-inducible patients (168 ± 29 ms vs. 136 ± 11 ms).
- Electrogram voltage and duration varied widely across atrial sites but did not correlate with either AF vulnerability or clinical recurrence.
Structured PICO
Does intracardiac contact mapping during incremental atrial pacing identify markers of AF vulnerability and recurrence in patients with paroxysmal AF?
PPopulation15 consecutive patients with paroxysmal atrial fibrillation (AF) and normal bipolar voltage mapping undergoing first-time pulmonary vein isolation
IInterventionIntracardiac contact mapping during multisite incremental atrial pacing (high right atrium and coronary sinus pacing)
OOutcomeVulnerability to AF induction at electrophysiology study and 2-year follow-up for arrhythmia recurrencesurrogate
Incremental atrial pacing identifies specific activation patterns, such as conduction delay at long coupling intervals and increased activation dispersion, that correlate with AF vulnerability and recurrence in patients with paroxysmal AF.