Sinus Rhythm Conduction Phenotyping Using Vector Flow Mapping in First-Time Atrial Fibrillation Ablation: Associations with Structural Remodeling and Thromboembolic Risk

Figures

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  Figure 1. BBS patterns and sinus-rhythm conduction phenotypes illustrated on high-density atrial maps. Arrows on each high-density atrial map indicate the instantaneous wavefront direction, with thicker arrows signifying slower local conduction (arrow thickness is inversely proportional to conduction velocity). A–D: 4 predefined vector-flow conduction phenotypes in sinus rhythm. A: Normal flow—uniformly thin, parallel vectors indicating coherent propagation with normal conduction velocity. B: CD—globally thickened, uniformly oriented vectors reflecting diffuse conduction slowing. C: CF—focal crowding of vectors (a “traffic-jam” pattern) with preserved overall orientation, consistent with a localized conduction bottleneck. D: DF—intersecting vectors traveling in 2 or more distinct directions, indicating fragmented wavefront propagation and heterogeneous conduction. Right: BBS patterns at the level of Bachmann’s bundle. The top row, labeled “Split (−),” shows single wavefront propagation across Bachmann’s bundle (ie, no BBS), in which a unified wavefront propagates into the left atrium without splitting. BBS is a sinus-rhythm phenotype defined by a single wavefront from the right atrium…

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  Figure 2. Distribution of the 8 MECE conduction phenotype categories. Patients were classified as normal, single-phenotype categories (CD only, CF only, DF only, BBS only), or multiphenotype-burden categories (double, triple, quadruple) according to the number of abnormal phenotype components present. Colors denote phenotype grouping (normal, green; single-phenotype, blue; multiphenotype burden, orange) and do not represent outcome risk. BBS = Bachmann’s bundle split; CD = conduction delay; CF = congested flow; DF = disrupted flow; MECE = mutually exclusive, collectively exhaustive.

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  Figure 3. 24-month arrhythmia-free survival by MECE conduction phenotype categories (exploratory). Kaplan–Meier curves showing arrhythmia-free survival over 24 months stratified by the 8 MECE conduction phenotype categories; the corresponding Firth analyses (Table 4) use normal as the common reference. The number at risk at each time point is shown below the time axis. The overall log-rank test was not statistically significant (P = .111). Detailed Firth penalized odds ratios for each MECE category vs normal are presented in Table 4. Category-specific estimates are exploratory and were not corrected for multiple comparisons. BBS = Bachmann’s bundle split; CD = conduction delay; CF = congested flow; CI = confidence interval; DF = disrupted flow; MECE = mutually exclusive, collectively exhaustive; OR = odds ratio.

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  Supplementary Figure.