Coronary sinus electrogram characteristics predict termination of AF with ablation and long‐term clinical outcome

Figures

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  Figure 1. (A–D) Demonstrates (A) STAR map in a posterior‐anterior view that shows an AFD on the high posterior wall. (B) Ablation here as shown on the CARTO map in a posterior‐anterior view resulted in AF termination to an AT as shown on the (C) BARD electrograms including PV signals, CS signals, ablation catheter signals (Map), and surface ECG. (D) BARD electrograms demonstrating a proportion of the unipolar CS signals obtained during the 5‐min recording post‐PVI. The electrograms demonstrate a stable CS activation pattern whereby CS 5 (highlighted by a star) is leading its neighboring electrodes as shown by the orange arrows. Throughout the 5‐min recording, this activation pattern was present 42% of the time, i.e., the activation pattern stability was 42%. As shown on the CS electrograms there was minimal CL variation within the CS with a CLV of 21 ms during the 5‐min recording. AF, atrial fibrillation; CLV, cycle length variability; CS, coronary sinus; ECG, electrocardiogram; PVI, pulmonary vein isolation

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  Figure 2. (A–D) Demonstrates (A) STAR map in an anterior‐posterior view that shows an AFD on the mid anterior wall. (B) Ablation here as shown on the CARTO map in an anterior‐posterior view resulted in AF termination to an AT as shown on the (C) BARD electrograms including PV signals, CS signals, ablation catheter signals (Map), and surface ECG. (D) BARD electrograms demonstrating a proportion of the unipolar CS signals obtained during the 5‐minute recording post‐PVI. The electrograms demonstrate a stable CS activation pattern whereby CS 10 (highlighted by a star) is leading its neighboring electrodes as shown by the orange arrows. Throughout the 5‐min recording, this activation pattern was present for 45% of the time, i.e., the activation pattern stability was 45%. As shown on the electrograms there was minimal CL variation within the CS with a CLV of 19.9 ms during the 5‐min recording. CLV, cycle length variability; CS, coronary sinus; ECG, electrocardiogram; PVI, pulmonary vein isolation

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  Figure 3. (A–C) Demonstrates Kaplan–Meier curves that show a significant difference in survival free from AF/AT in patients based on differences in (A) CS activation pattern stability whereby patients with a CS activation pattern stability of ≥30% have an increase survival free from AF/AT compared with patients with a CS activation pattern stability of <30%. (B) CS CLV whereby patients with a CS CLV of <30 ms have an increase survival free from AF/AT compared with patients with a CS CLV of ≥30 ms. (C) Proportion of LVZs whereby patients with a proportion of LVZs of <30% have an increased survival free from AF/AT compared to patients with a proportion of LVZs of ≥30%. AF, atrial fibrillation; AT, atrial tachycardia; CLV, cycle length variability; CS, coronary sinus; LVZs, low voltage zones