Hierarchical analysis of electrograms to guide termination of persistent atrial fibrillation

Figures

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  Figure 1. Distribution of focal sources (FS) and ablation lesions in the left atrium (LA). A: Distribution of FS (blue tags) in the LA and pulmonary veins (PV) shown in posteroanterior (left) and anteroposterior (right) views. B: Circumferential PV ablation (red tags) and FS ablation (red tags) sites. C: Termination of AF during ablation of FS at the base of the left atrial appendage (LAA) (white arrow).

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  Figure 2. Periodicity map and EGM features of focal sources (FS). The left panel shows spatial distribution of dominant periodicities and their periodicity cycle length (CL) in the left atrium (LA) and pulmonary veins (PVs). White asterisk indicates FS location. AP = anteroposterior view; PA = posteroanterior view. The right panel shows bipolar and unipolar EGMs of selected LA and PV sites. Red dashed vertical lines indicate periodic activations in the bipolar EGM, which are transposed to the corresponding unipolar EGM. A: FS inside the right upper PV with unipolar QS complexes (dashed arrows). B: Fastest periodicity CL in the right inferior PV with a unipolar RS complex (solid arrows). C: FS at the base of the left atrial appendage (LAA) where AF terminated with ablation, showing unipolar QS complexes (dashed arrows). Black asterisk indicates location of this FS. D: CFAE site in the right PV carina close to FS with no periodicity or unipolar QS complex.

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  Figure 3. EGMs of focal source (FS) where AF terminated with ablation. The left panel shows a circular catheter. Red star indicates FS recording site. Arrows indicate wave propagation away from FS to adjacent bipoles (B) and unipoles (U). The right panels indicate bipolar and unipolar EGMs of FS and adjacent electrodes, confirming wave propagation away from FS (black arrows). Dashed vertical lines indicate periodic activations in the focal source - bipolar (FSB) recording channel, which are extended to adjacent bipolar channels and transposed to unipolar channels to provide a timing reference relative to the FSB channel.