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Abstract Background The contribution of organized patterns of excitation as mechanisms maintaining persistent atrial fibrillation (PAF) is questioned. Purpose We aim to analyze the relationship of focal and reentrant activities, identified with the CARTO-Finder system, with tissue structure and activation rate to explain potential link with mechanisms and outcomes. Methods 33 patients with PAF of at least 6 months (24±4 months) were admitted for right and left atrial (RA p0.001). The higher the number of consecutive focal activities, the higher the tissue activation rate (DF no focal activities 5.7±0.09 Hz vs DF 1-5 focal activities 6.0±0.14 Hz vs DF5 focal activities 6.2±0.14 Hz; p0.001). In addition, DF at focal activities strongly correlates with DF at areas without organized patterns (Pearson 0.91; p0.001). The bipolar voltage was higher at places with focal activities compared with areas without organized patterns (1.0±0.04 mV vs 0.5±0.04 mV; p0.001). None of the previous were observed at places with rotational activities (DF: 5.9±0.16 Hz vs 5.7±0.09 Hz; p=0.204 p=0.364). During follow-up after ablation (24±7 months), a cox regression model including number of focal activities, number of rotations, mean tissue activation rate (mean DF) and bipolar voltage, identified bipolar voltage as a unique independent predictor of survival free of AF recurrence (p=0.04). Conclusions Focal activities identified with the CARTO Finder system during PAF in humans correlate with tissue structure and activation rate, suggesting a potential link with mechanisms.
Alonso et al. (Wed,) studied this question.