Impact of adenosine on mechanisms sustaining persistent atrial fibrillation: Analysis of contact electrograms and non-invasive ECGI mapping data

Figures

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  Fig 1. Flowchart of phenotype AF: Adenosine sub study. Flowchart describing how patients enrolled into the Phenotype AF study were recruited to this sub study.

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  Fig 2. Image from the ECGI system showing a focal activation being reviewed. Screenshot from the ECGI workstation software. This screen allows the operator to select any potential focal or rotational driver and for review. Far left: LAO view of the composite biatrial map displaying focal PDs (orange hexagons) and yellow/orange areas as a heat map with darker colour showing greater number of rotational PDs occurrences. A selected focal PD is highlighted in green. Right image: a phase map with the activation sequence for that focal PD with the blue region showing the site of earliest activation, spreading out through light blue, green, then yellow and red colours. The raw unipolar electrogram is displayed on the bottom right panel. The software can display the unipolar electrograms from any point on the phase map.

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  Fig 3. Cycle length measurements at baseline and with adenosine. Cycle length measurements from the same patient at baseline and with Adenosine. The surface ECG leads are shown at the top (blue channels) with a quadripolar catheter in the right atrial appendage (green channels) and the Achieve mapping catheter in the left atrial appendage (yellow channels). Cycle length recordings taken in this patient at the RAA are shorter in the Adenosine maps compared to baseline but are similar in both at the LAA.

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  Fig 4. ECGI composites maps at baseline and with adenosine. ECGI Composite maps from the same patient at baseline and with Adenosine. In this figure the orange hexagons represent focal drivers and the yellow/orange areas are regions where rotational drivers have been detected. The numbers in the diagram represent the number of revolutions completed for each rotational PD occurrence in that region. the overall burden and distribution of PDs is very similar, but the proportion of PDs that are focal is arguable slightly increased in the maps following administration of adenosine.