Identification of high priority focal activations in persistent atrial fibrillation using a novel mapping strategy

Shimojo, Makoto; Inden, Yasuya; Riku, Shuro; Suga, Kazumasa; Furui, Koichi; Nakagomi, Takahiro; Okajima, Takashi; Shibata, Rei; Murohara, Toyoaki

doi:10.1007/s00380-021-01977-x

Cited by 3 publications

(5 citation statements)

References 21 publications

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“…Regarding the characteristics of focal and rotational activations identified by CARTOFINDER using the PetaRay catheter, our previous study using CARTOFINDER with the PetaRay catheter showed that focal activation were detected at sites with shorter AF‐CL and standard deviation of CL 5 . Similarly, Shimojo et al, reported that focal activation sites identified by CARTOFINDER were more frequently located at sites with a shorter dominant CL, which was defined as the most frequent value of CL 9 . Similar trends were observed in focal and rotational activations identified by CARTOFINDER using the OctaRay catheter, both reliable focal and rotational activation sites was characterized by shorter AF‐CL.…”

Section: Discussionmentioning

confidence: 94%

“…[13][14][15] Shiomjo et al reported that AF termination rate increased by adding ablation to sites with dominant AF-CL in manually arranged local activation time mapping from CARTODFIN-DER mapping. 9 CARTO version 8 allows for automatic display of dominant AF-CL mapping in CARTOFINDER mapping. Among the current study patients, we experienced a case of direct AF termination during ablation targeting concomitant focal activation sites with short AF-CL after PVI (Figure 6).…”

Section: Discussionmentioning

confidence: 99%

“…Short dominant CL, as well as complex fractionated atrial electrograms defined as fractionated AF with short AF‐CL, could be a potential tailored target to ablate for persistent AF 13–15 . Shiomjo et al reported that AF termination rate increased by adding ablation to sites with dominant AF‐CL in manually arranged local activation time mapping from CARTODFINDER mapping 9 . CARTO version 8 allows for automatic display of dominant AF‐CL mapping in CARTOFINDER mapping.…”

Section: Discussionmentioning

confidence: 99%

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Reliable focal and rotational activations in CARTOFINDER mapping using the OctaRay catheter

Kawaji,

Aizawa,

Yamano

et al. 2023

Cardiovasc electrophysiol

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IntroductionThe aim of the current study was to elucidated the reliable atrial fibrillation (AF) drivers identified by CARTOFINDER using OctaRay catheter.Methods and ResultsThe reliability of focal and rotational activations identified by CARTOFINDER using OctaRay catheter was assessed by the sequential recordings in each site of both atrium before and after pulmonary vein isolation (PVI) in 10 persistent AF patients. The outcome measures were the reproducibility rate during the sequential recordings and the stability rate between pre‐ and post‐PVI as reliable focal and rotational activations. The study results were compared with those under use of PentaRay catheter (N = 18). Total 68928 points of 360 sites in OctaRay group and 24 177 points of 311 sites in PentaRay were assessed. More focal activation sites were identified in OctaRay group than PentaRay group (7.9% vs. 5.7%, p < .001), although the reproducibility rate and the stability rate were significantly lower in OctaRay group (45.3% vs. 58.9%, p < .001; 11.2% vs. 28.4%, p < .001). Meanwhile, the prevalence of reproducible focal activation sites among overall points was comparable (3.6% vs. 3.3%, p = .08). Regarding rotational activation, more rotational activation sites were identified in OctaRay group (5.1% vs. 0.2%, p < .001), and the reproducibility rate and the stability rate were significantly higher in OctaRay group (45.2% and 12.5% vs. 0.0%, p < .001). Both reliable focal and rotational activation sites were characterized by significantly shorter AF‐cycle length (CL) and higher repetition of focal and rotational activations during the recordings compared with the sites of non or unreliable focal and rotational activations.ConclusionIn CARTOFINDER, OctaRay catheter could identify reliable focal activation with high resolution and reliable rotational activation compared with PentaRay catheter. The repetitive focal and rotational activations with short AF‐CL could be the potential target during ablation.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Reliable focal and rotational activations in CARTOFINDER mapping using the OctaRay catheter

Kawaji,

Aizawa,

Yamano

et al. 2023

Cardiovasc electrophysiol

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“…2 A new driverguided method has emerged as an alternative approach, and other various mapping methods have yielded some encouraging results in small populations. [3][4][5][6][7] Previous prospective studies by Lin et al 8 and Narayan et al 9 evaluated the substrate modification guided by repetitive and/or organized similar electrography to eliminate rotors and focal sources. From these studies, electrogram similarity analysis could be used to detect regions with stable activation waveforms in the atria regardless of the spatial wavefront propagations.…”

Section: Introductionmentioning

confidence: 99%

“…The optimal ablation strategy for persistent AF remains undetermined, and an alternative approach should be explored . A new driver-guided method has emerged as an alternative approach, and other various mapping methods have yielded some encouraging results in small populations …”

Section: Introductionmentioning

confidence: 99%

Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation

Lin,

Higa

et al. 2023

JAMA Netw Open

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ImportanceCatheter ablation for persistent atrial fibrillation (AF) has shown limited success.ObjectiveTo determine whether AF drivers could be accurately identified by periodicity and similarity (PRISM) mapping ablation results for persistent AF when added to pulmonary vein isolation (PVI).Design, Setting, and ParticipantsThis prospective randomized clinical trial was performed between June 1, 2019, and December 31, 2020, and included patients with persistent AF enrolled in 3 centers across Asia. Data were analyzed on October 1, 2022.InterventionPatients were assigned to the PRISM-guided approach (group 1) or the conventional approach (group 2) at a 1:1 ratio.Main Outcomes and MeasuresThe primary outcome was freedom from AF or other atrial arrhythmia for longer than 30 seconds at 6 and 12 months.ResultsA total of 170 patients (mean [SD] age, 62.0 [12.3] years; 136 men [80.0%]) were enrolled (85 patients in group 1 and 85 patients in group 2). More group 1 patients achieved freedom from AF at 12 months compared with group 2 patients (60 [70.6%] vs 40 [47.1%]). Multivariate analysis indicated that the PRISM-guided approach was associated with freedom from the recurrence of atrial arrhythmia (hazard ratio, 0.53 [95% CI, 0.33-0.85]).Conclusions and RelevanceThe waveform similarity and recurrence pattern derived from high-density mapping might provide an improved guiding approach for ablation of persistent AF. Compared with the conventional procedure, this novel specific substrate ablation strategy reduced the frequency of recurrent AF and increased the likelihood of maintenance of sinus rhythm.Trial RegistrationClinicalTrials.gov Identifier: NCT05333952

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Identification of regions maintaining atrial fibrillation through cycle length and cycle length gradient mapping

Shimojo,

Inden,

Yanagisawa

et al. 2024

Journal of Arrhythmia

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BackgroundVisualizing the specific regions where atrial fibrillation (AF) is maintained is crucial for effective treatment, but it remains challenging in clinical practice. We aimed to address this challenge by developing a mapping approach focused on the cycle length (CL) and its gradient (CL‐gradient).MethodsIn 105 patients undergoing initial ablation for persistent AF, pre‐ablation CARTOFINDER data were utilized to create maps based on three indicators: (1) CL, the atrial frequency during AF calculated using CARTOFINDER; (2) Short CL, encompassing CLs within 5 ms of the minimum CL; and (3) CL‐gradient, the CL range within a 6 mm radius. We evaluated the association between the AF termination through ablation and the measured values and patterns in each map.ResultsAF termination occurred in 17 patients. The AF termination group exhibited the significant large maximum CL‐gradient (48.8 ms [interquartile range, 38.6–66.3], p <.001) and the short distance between the minimum CL site and the maximum CL‐gradient site (15.8 mm, [interquartile range, 6.0–23.2], p =.029). Of the 17 AF termination cases, 13 exhibited a CL distribution pattern characterized by a steep CL‐gradient near the minimum CL site (SG‐MCL), defined as the distance of less than 23.2 mm and the maximum CL‐gradient greater than 33.1 ms. In these AF termination cases, SG‐MCL was also correlated with the ablation area.ConclusionsThe minimum CL area accompanied by significant CL gradients in the immediate vicinity may play a crucial role in sustaining AF.

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Identification of high priority focal activations in persistent atrial fibrillation using a novel mapping strategy

Cited by 3 publications

References 21 publications

Reliable focal and rotational activations in CARTOFINDER mapping using the OctaRay catheter

Reliable focal and rotational activations in CARTOFINDER mapping using the OctaRay catheter

Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation

Identification of regions maintaining atrial fibrillation through cycle length and cycle length gradient mapping

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