Benefits of Atrial Substrate Modification Guided by Electrogram Similarity and Phase Mapping Techniques to Eliminate Rotors and Focal Sources Versus Conventional Defragmentation in Persistent Atrial Fibrillation

JACC. Clinical Electrophysiology
Y K LinShih-Ann Chen

Abstract

This prospective study compared the efficacy of atrial substrate modification guided by a nonlinear phase mapping technique with that of conventional substrate ablation. The optimal ablation strategy for persistent atrial fibrillation (AF) was unknown. In phase 1 study, we applied a cellular automation technique to simulate the electrical wave propagation to improve the phase mapping algorithm, involving analysis of high-similarity electrogram regions. In addition, we defined rotors and focal AF sources, using the physical parameters of the divergence and curvature forces. In phase 2 study, we enrolled 68 patients with persistent AF undergoing substrate modification into 2 groups, group-1 (n = 34) underwent similarity index (SI) and phase mapping techniques; group-2 (n = 34) received complex fractionated atrial electrogram ablation with commercially available software. Group-1 received real-time waveform similarity measurements in which a phase mapping algorithm was applied to localize the sources. We evaluated the single-procedure freedom from AF. In group-1, we identified an average of 2.6 ± 0.89 SI regions per chamber. These regions involved rotors and focal sources in 65% and 77% of patients in group-1, respectively. Group-...Continue Reading

References

Jan 24, 2002·Nature·Stanley Nattel
Apr 4, 2006·Journal of the American College of Cardiology·Yenn-Jiang LinShih-Ann Chen
Sep 4, 2007·Journal of Cardiovascular Electrophysiology·Shih-Lin ChangShih-Ann Chen
Mar 4, 2008·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Yenn-Jiang LinShih-Ann Chen
Oct 8, 2009·Circulation. Arrhythmia and Electrophysiology·Yenn-Jiang LinShih-Ann Chen
Jun 19, 2010·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Yenn-Jiang LinShih-Ann Chen
Aug 29, 2013·Circulation. Arrhythmia and Electrophysiology·Yenn-Jiang LinShih-Ann Chen
Jul 17, 2014·Circulation·Michel HaissaguerreRemi Dubois
May 7, 2015·The New England Journal of Medicine·Atul VermaUNKNOWN STAR AF II Investigators

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Citations

Aug 12, 2017·Journal of Cardiovascular Electrophysiology·F Daniel RamirezPablo B Nery
Jan 14, 2018·Circulation. Arrhythmia and Electrophysiology·Junaid A B ZamanNicholas S Peters
Dec 6, 2018·Current Opinion in Cardiology·Yenn-Jiang LinShih-Ann Chen
Jul 30, 2019·Circulation. Arrhythmia and Electrophysiology·George LeefSanjiv M Narayan
Apr 11, 2018·Arrhythmia & Electrophysiology Review·Ian MannPrapa Kanagaratnam
Jan 10, 2018·Journal of Cardiovascular Electrophysiology·Yoshihide TakahashiKenzo Hirao
May 11, 2018·Circulation. Arrhythmia and Electrophysiology·Tina BaykanerPaul A Heidenreich
Feb 9, 2021·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Xiaofeng HuMu Qin
Jun 8, 2021·European Cardiology·Giulio La RosaDavid Filgueiras-Rama

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