Spatiotemporal Stability of Persistent Atrial Fibrillation Sources: Stable Source or Disease Progression?

Aims: To assess the spatiotemporal stability of extra-pulmonary vein (PV) sources in patients with persistent atrial fibrillation (AF). Methods and results: Nine patients (mean age 63 ± 9 years, 55% male) with persistent AF were included who underwent an initial and at least one redo catheter ablation procedure utilizing panoramic atrial mapping (PAM) systems (CardioInsight, electrographic flow (EGF), and/or charge density (CDM) mapping). Procedures were performed in the following combinations: CDM-CDM (1 patient), CDM-EGF (1 patient), EGF-CDM (3 patients), CardioInsight-CDM (1 patient), EGF-EGF (3 patients). We reviewed maps and analyzed the location of AF sources. Spatiotemporal stability was defined as the presence of an AF source of identical location on available maps during the initial and the redo procedure. In 4 patients (44.4%), localization of AF sources mapped at the repeat procedure corresponded with the localization of sources mapped during the index procedure. In two patients, no sources were identified during the second procedure. In the remaining 3 patients, the localization of sources was detected at different locations. Conclusions: Our findings suggest the presence of spatiotemporal stability of AF sources; however, novel sources can also be found during the repeated procedure, consistent with disease progression.