Automated electrogram fractionation mapping (signal width 15ms, refractoriness 25ms, amplitude threshold 0.05mV) identified sites of autonomic response with 74.1% sensitivity and 73.9% specificity.
Cohort (n=26)
Does automated electrogram fractionation mapping accurately identify sites of autonomic responses during cardioneuroablation?
Automated electrogram fractionation mapping with specific parameters (signal width 15 ms, refractoriness 25 ms, amplitude threshold 0.05 mV) can effectively identify sites of autonomic responses during cardioneuroablation.
ABSTRACT Background Cardioneuroablation (CNA) targets atrial ganglionated plexuses (GP) to treat vagally mediated bradyarrhythmias. Automated electrogram fractionation mapping has been proposed as a surrogate tool for GP localization, but optimal parameter settings remain undefined. We aimed to systematically evaluate automated fractionation mapping parameters and their association with autonomic responses during ablation. Methods Data from 26 patients were analyzed, including 12 patients undergoing atrial fibrillation (AF) ablation in sinus rhythm and 14 patients undergoing CNA. Using high‐density electroanatomical mapping, three predefined values were tested for each fractionation parameter—signal width, refractoriness, and amplitude threshold—yielding 27 automated configurations. A purely anatomical localization strategy was also evaluated. In the AF cohort, all configurations were systematically assessed, generating 336 fractionation maps and 870 ablation sites. Autonomic response during radiofrequency delivery was defined as an absolute RR interval change > 10%. Selected high‐performing configurations were subsequently evaluated in the CNA cohort (614 ablation sites). Results In the AF cohort, 25 of 27 configurations showed a significant association with autonomic response. After Bonferroni correction, 15 configurations remained significant. The configuration with signal width 15 ms, refractoriness 25 ms, and amplitude threshold 0.05 mV demonstrated the highest sensitivity, although several configurations showed comparable performance. When evaluated in the CNA cohort, this configuration yielded a sensitivity of 74.1% and specificity of 73.9%. Conclusions This pilot study provides a reproducible framework for evaluating automated fractionation mapping parameters associated with autonomic responses during CNA. The findings support biologically plausible parameter–performance relationships and identify parameter ranges potentially suitable for procedural use.
Uribe et al. (Wed,) conducted a cohort in Vagally mediated bradyarrhythmias and atrial fibrillation (n=26). Automated electrogram fractionation mapping vs. Purely anatomical localization strategy was evaluated on Autonomic response during radiofrequency delivery (absolute RR interval change > 10%). Automated electrogram fractionation mapping (signal width 15ms, refractoriness 25ms, amplitude threshold 0.05mV) identified sites of autonomic response with 74.1% sensitivity and 73.9% specificity.