Key result
Localized irregular activation shows substantially greater spatiotemporal stability during AF than localized rotational activation.
Why the study?
The spatial stability, conduction characteristics, and optimal mapping duration needed to reveal localized rotational, irregular, and focal activation during charge density mapping of AF had not been explored.
Observational (n=21)
Localized irregular activation represents a highly stable mapping pattern during atrial fibrillation compared to transient localized rotational activation, suggesting it may better reflect fixed structural substrates for targeted ablation.
Answers are grounded in this paper and cite their sources.
LIA stability may guide targeted AF mapping; hypothesis-generating and requires prospective trials before any practice change.
Background Charge density mapping of atrial fibrillation (AF) reveals dynamic localized rotational activation (LRA), irregular activation (LIA) and focal firing (FF). Their spatial stability, conduction characteristics and the optimal duration of mapping required to reveal these phenomena and has not been explored. Methods Bi‐atrial mapping of AF propagation was undertaken using AcQMap (Acutus Medical) and variability of activation patterns quantified up to a duration of 30 s. The frequency of each pattern was quantified at each unique point of the chamber over two separate 30‐s recordings before ablation and R 2 calculated to quantify spatial stability. Regions with the highest frequency were identified at increasing time durations and compared to the result over 30 s using Cohen's kappa. Properties of regions with the most stable patterns were assessed during sinus rhythm and extrastimulus pacing. Results In 21 patients, 62 paired LA and RA maps were obtained. LIA was highly spatially stable with R 2 between maps of 0.83 (0.71–0.88) compared to 0.39 (0.24–0.57), and 0.64 (0.54–0.73) for LRA and FF, respectively. LIA was most temporally stable with a kappa of >0.8 reached by 12 s. LRA showed greatest variability with kappa >0.8 only after 22 s. Regions of LIA were of normal voltage amplitude (1.09 mv) but showed increased conduction heterogeneity during extrastimulus pacing ( p = .0480). Conclusion Irregular activation patterns characterized by changing wavefront direction are temporally and spatially stable in contrast with LRA that is transient with least spatial stability. Focal activation appears of intermediate stability. Regions of LIA show increased heterogeneity following extrastimulus pacing and may represent fixed anatomical substrate.
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Pope et al. (2021) conducted an observational in Atrial fibrillation (paroxysmal or persistent) undergoing first-time catheter ablation (n=21). Charge-density mapping of atrial fibrillation was evaluated on Spatial and temporal stability of localized irregular activation (LIA) vs localized rotational activation (LRA) (R2 0.83 for LIA vs 0.39 for LRA). Localized irregular activation (LIA) during atrial fibrillation was highly spatially and temporally stable compared to localized rotational activation (LRA).
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