Rapid pacing at 300 ms revealed significantly slower conduction velocity in persistent AF compared to paroxysmal AF and controls (0.60 vs. 0.72 vs. 0.90 m/s; p<0.001).
Cohort (n=46)
Does high-density omnipolar mapping under rapid pacing reveal latent substrate abnormalities compared to sinus rhythm mapping in patients with atrial fibrillation?
Rapid pacing at 300 ms during high-density mapping unmasks latent bi-atrial substrate abnormalities not seen in sinus rhythm, which may improve risk stratification for AF recurrence.
Absolute Event Rate: 0.6% vs 0.9%
p-value: p=<0.001
ABSTRACT Background Substrate mapping for atrial fibrillation (AF) ablation commonly relies on sinus rhythm (SR) maps, which may overlook rate‐dependent electrophysiological changes. Objective This study aimed to evaluate the diagnostic and prognostic value of rate‐dependent substrate characterization using high‐density omnipolar mapping under rapid pacing. Methods In a prospective cohort of 46 patients (5 controls, 22 paroxysmal AF PAF, 19 persistent AF PeAF), bi‐atrial conduction velocity (CV) and low‐voltage zones (LVZ) were assessed across seven mapping conditions: SR and graded pacing (600, 400, 300 ms) from the distal coronary sinus (CSD) and high right atrium (HRA). Results CV decreased with faster pacing across all cohorts. At 300 ms, PeAF patients exhibited significantly slower CV than PAF and controls (0.60 ± 0.07 vs. 0.72 ± 0.06 vs. 0.90 ± 0.05 m/s; p 43.4% (AUC 0.681; p = 0.008) at 300 ms were associated with a higher risk of recurrence. Conclusion Rapid pacing at 300 ms reveals latent bi‐atrial substrate occult during SR and may improve risk stratification.
Wang et al. (Fri,) conducted a cohort in Atrial fibrillation (n=46). High-density omnipolar mapping under rapid pacing vs. Sinus rhythm mapping and healthy controls was evaluated on Bi-atrial conduction velocity at 300 ms pacing (p=<0.001). Rapid pacing at 300 ms revealed significantly slower conduction velocity in persistent AF compared to paroxysmal AF and controls (0.60 vs. 0.72 vs. 0.90 m/s; p<0.001).