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Mahtani AU, Gabrah K, Nair DG. Stochastic Trajectory Analysis of Ranked Signals (STAR) Apollo mapping system approach to treat persistent atrial fibrillation: A case report. HeartRhythm Case Rep 2024; 10:517-520. [PMID: 39155897 PMCID: PMC11328572 DOI: 10.1016/j.hrcr.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Affiliation(s)
| | | | - Devi G. Nair
- Arrhythmia Research Group, Jonesboro, Arkansas
- Department of Electrophysiology, St. Bernards Medical Center, Jonesboro, Arkansas
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2
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Honarbakhsh S, Schilling RJ, Keating E, Finlay M, Hunter RJ. Coronary sinus electrogram characteristics predict termination of AF with ablation and long-term clinical outcome. J Cardiovasc Electrophysiol 2022; 33:2139-2151. [PMID: 35775822 PMCID: PMC9796101 DOI: 10.1111/jce.15618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/10/2022] [Accepted: 06/29/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Markers predicting atrial fibrillation (AF) termination and freedom from AF/atrial tachycardia (AT) has been proposed. This study aimed to evaluate the role of novel coronary sinus (CS) electrogram characteristics in predicting the acute ablation response and freedom from AF/AT during follow-up. METHODS Patients undergoing ablation for persistent AF as part of the Stochastic Trajectory Analysis of Ranked signals mapping study were included. Novel CS electrogram characteristics including CS cycle length variability (CLV) and CS activation pattern stability (APS) and proportion of low voltage zones (LVZs) were reviewed as potential predictors for AF termination on ablation and freedom from AF/AT during follow-up. The relationship between localized driver characteristics and CS electrogram characteristics was also assessed. RESULTS Sixty-five patients were included. AF termination was achieved in 51 patients and 80% of patients were free from AF/AT during a follow-up of 29.5 ± 3.7 months. CS CLV of <30 ms, CS APS of ≥30% and proportion of LVZ < 30% showed high diagnostic accuracy in predicting AF termination on ablation and freedom from AF/AT during follow-up (CS CLV odds ratio [OR] 25.6, area under the curve [AUC] 0.91; CS APS OR 15.9, AUC 0.94; proportion of LVZs OR 21.4, AUC 0.88). These markers were independent predictors of AF termination on ablation and AF/AT recurrence during follow-up. Ablation of a smaller number of drivers that demonstrate greater dominance strongly correlate with greater CS organization. CONCLUSION Novel CS electrogram characteristics were independent predictors of AF termination and AF/AT recurrence during follow-up. These markers can potentially aid in predicting outcomes and guide ablation and follow-up strategies.
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Affiliation(s)
- Shohreh Honarbakhsh
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
| | - Richard J. Schilling
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
| | - Emily Keating
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
| | - Malcolm Finlay
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
| | - Ross J. Hunter
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
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Kotb A, Chin SH, Ng GA. Recent advances in the tools available for atrial fibrillation ablation. Expert Rev Med Devices 2022; 19:141-154. [PMID: 35188431 DOI: 10.1080/17434440.2022.2038564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/02/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the commonest arrhythmia in clinical practice with significant detrimental health impacts. Much effort has been spent in mapping AF, determine its triggers and drivers, and how to develop tools to eliminate these triggers. AREAS COVERED In this state of-the-art review article, we aim to highlight the recent techniques in catheter-based management of Atrial Fibrillation; including new advancements either in the catheter design or the software used. This includes a comprehensive summary of the most recent tools used in AF mapping and subsequent ablation. EXPERT OPINION Electrical isolation of the pulmonary veins has been developed and established as the cornerstone in AF ablation with good results in patients with paroxysmal AF (PAF) whilst new ablation tools are aimed at streamlining the procedure. However, the quest for persistent AF (PeAF) remains. The future of AF ablation, we believe, lies in identifying AF drivers by means of the new developing mapping tools and altering their electrical properties in a safe, reproducible, and effective manner.
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Affiliation(s)
- Ahmed Kotb
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Shui Hao Chin
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - G Andre Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
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Rodrigo M, Narayan SM. Re-interpreting complex atrial tachycardia maps using global atrial vectors. J Cardiovasc Electrophysiol 2021; 32:1918-1920. [PMID: 33955113 PMCID: PMC9836027 DOI: 10.1111/jce.15073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Miguel Rodrigo
- Cardiovascular Institute, Stanford University, Stanford, CA, USA,Electronic Engineering Department, Universitat de Valencia, Spain
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5
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Honarbakhsh S, Schilling RJ, Providencia R, Dhillon G, Bajomo O, Keating E, Finlay M, Hunter RJ. Ablation guided by STAR-mapping in addition to pulmonary vein isolation is superior to pulmonary vein isolation alone or in combination with CFAE/linear ablation for persistent AF. J Cardiovasc Electrophysiol 2021; 32:200-209. [PMID: 33368766 PMCID: PMC8607469 DOI: 10.1111/jce.14856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/19/2020] [Accepted: 11/27/2020] [Indexed: 11/18/2022]
Abstract
Introduction The optimal ablation approach for persistent atrial fibrillation (AF) remains unclear. Methods and Results Objective was to compare the long‐term rates of freedom from AF/AT in patients that underwent STAR mapping guided ablation against outcomes of patients undergoing conventional ablation procedures. Patients undergoing ablation for persistent AF as part of the Stochastic Trajectory Analysis of Ranked signals (STAR) mapping study were included. Outcomes following 'pulmonary vein isolation (PVI) plus STAR mapping guided ablation (STAR mapping cohort) were compared to patients undergoing PVI alone ablation during the same time period and also a propensity‐matched cohort undergoing PVI plus the addition of complex fractionated electrogram (CFAE) and/or linear ablation (“conventional ablation”). Rates of procedural AF termination and freedom from AF/AT during follow‐up were compared. Sixty‐five patients were included in both the STAR cohort and propensity matched conventional ablation cohort. AF termination rates were significantly higher in the STAR cohort (51/65, 78.5%) than conventional ablation cohort (10/65, 15.4%) and PVI alone ablation cohort (13/50, 26.0%; STAR cohort vs. other 2 cohorts both p < .001). There was no significant difference in procedure time between the three cohorts. During ≥20 months follow‐up a lower proportion of patients had AF/AT recurrence in the STAR cohort (20.0%) compared with the conventional ablation cohort (50.8%) or the PVI alone ablation cohort (50.0%; both p < .05 compared to STAR cohort). Conclusions Outcomes of PVI plus STAR mapping guided ablation was superior to PVI alone or in combination with linear/CFAE ablation. A multicenter randomized controlled trial is planned to confirm these findings.
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Affiliation(s)
| | | | | | | | | | - Emily Keating
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | - Ross J Hunter
- Barts Heart Centre, Barts Health NHS Trust, London, UK.,Queen Mary University of London
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Honarbakhsh S, Schilling RJ, Finlay M, Keating E, Hunter RJ. Prospective STAR-Guided Ablation in Persistent Atrial Fibrillation Using Sequential Mapping With Multipolar Catheters. Circ Arrhythm Electrophysiol 2020; 13:e008824. [PMID: 32903033 PMCID: PMC7566307 DOI: 10.1161/circep.120.008824] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A novel stochastic trajectory analysis of ranked signals (STAR) mapping approach to guide atrial fibrillation (AF) ablation using basket catheters recently showed high rates of AF termination and subsequent freedom from AF. METHODS This study aimed to determine whether STAR mapping using sequential recordings from conventional pulmonary vein mapping catheters could achieve similar results. Patients with persistent AF<2 years were included. Following pulmonary vein isolation AF drivers (AFDs) were identified on sequential STAR maps created with PentaRay, IntellaMap Orion, or Advisor HD Grid catheters. Patients had a minimum of 10 multipolar recordings of 30 seconds each. These were processed in real-time and AFDs were targeted with ablation. An ablation response was defined as AF termination or cycle length slowing ≥30 ms. RESULTS Thirty patients were included (62.4±7.8 years old, AF duration 14.1±4.3 months) of which 3 had AF terminated on pulmonary vein isolation, leaving 27 patients that underwent STAR-guided AFD ablation. Eighty-three potential AFDs were identified (3.1±1.1 per patient) of which 70 were targeted with ablation (2.6±1.2 per patient). An ablation response was seen at 54 AFDs (77.1% of AFDs; 21 AF termination and 33 cycle length slowing) and occurred in all 27 patients. No complications occurred. At 17.3±10.1 months, 22 out of 27 (81.5%) patients undergoing STAR-guided ablation were free from AF/atrial tachycardia off antiarrhythmic drugs. CONCLUSIONS STAR-guided AFD ablation through sequential mapping with a multipolar catheter effectively achieved an ablation response in all patients. AF terminated in a majority of patients, with a high freedom from AF/atrial tachycardia off antiarrhythmic drugs at long-term follow-up. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02950844.
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Affiliation(s)
| | | | - Malcolm Finlay
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Emily Keating
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
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Koneshloo A, Du D, Du Y. An Uncertainty Modeling Framework for Intracardiac Electrogram Analysis. Bioengineering (Basel) 2020; 7:E62. [PMID: 32604784 PMCID: PMC7355499 DOI: 10.3390/bioengineering7020062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 11/16/2022] Open
Abstract
Intracardiac electrograms (EGMs) are electrical signals measured within the chambers of the heart, which can be used to locate abnormal cardiac tissue and guide catheter ablations to treat cardiac arrhythmias. EGMs may contain large amounts of uncertainty and irregular variations, which pose significant challenges in data analysis. This study aims to introduce a statistical approach to account for the data uncertainty while analyzing EGMs for abnormal electrical impulse identification. The activation order of catheter sensors was modeled with a multinomial distribution, and maximum likelihood estimations were done to track the electrical wave conduction path in the presence of uncertainty. Robust optimization was performed to locate the electrical impulses based on the local conduction velocity and the geodesic distances between catheter sensors. The proposed algorithm can identify the focal sources when the electrical conduction is initiated by irregular electrical impulses and involves wave collisions, breakups, and spiral waves. The statistical modeling framework can efficiently deal with data uncertainties and provide a reliable estimation of the focal source locations. This shows the great potential of a statistical approach for the quantitative analysis of the stochastic activity of electrical waves in cardiac disorders and suggests future investigations integrating statistical methods with a deterministic geometry-based method to achieve advanced diagnostic performance.
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Affiliation(s)
- Amirhossein Koneshloo
- Department of Industrial, Manufacturing and Systems Engineering, Texas Tech University, Lubbock, TX 79409, USA
| | - Dongping Du
- Department of Industrial, Manufacturing and Systems Engineering, Texas Tech University, Lubbock, TX 79409, USA
| | - Yuncheng Du
- Department of Chemical & Biomolecular Engineering, Clarkson University, Potsdam, NY 13699, USA
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Honarbakhsh S, Schilling RJ, Keating E, Finlay M, Hunter RJ. Drivers in AF colocate to sites of electrogram organization and rapidity: Potential synergy between spectral analysis and STAR mapping approaches in prioritizing drivers for ablation. J Cardiovasc Electrophysiol 2020; 31:1340-1349. [PMID: 32219906 DOI: 10.1111/jce.14456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/27/2020] [Accepted: 03/16/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Stochastic trajectory analysis of ranked signals (STAR) mapping has recently been used to ablate persistent atrial fibrillation (AF) with high rates of AF termination and long-term freedom from AF in small, single-arm studies. We hypothesized that rapidity and organization markers would correlate with early sites of activation (ESA). METHODS Patients undergoing persistent AF ablation as part of the STAR mapping study were included. Five-minute unipolar basket recordings used to create STAR maps were used to determine the minimum-cycle length (Min-CL) and CL variability (CLV) at each electrode to identify the site of the fastest Min-CL and lowest CLV across the left atrium (LA). The location of ESA targeted with ablation was compared with these sites. Dominant frequency was assessed at ESA and compared with that of neighboring electrodes to assess for regional gradients. RESULTS Thirty-two patients were included with 83 ESA ablated, with an ablation response at 73 sites (24 AF termination and 49 CL slowing ≥30 ms). Out of these, 54 (74.0%) and 56 (76.7%) colocated to sites of fastest Min-CL and lowest CLV, respectively. Regional CL and frequency gradients were demonstrable at majority of ESA. ESA colocating to sites of fastest Min-CL and lowest CLV were more likely to terminate AF with ablation (odds ratio, 34 and 29, respectively, P = .02). These showed a moderate sensitivity (74.0% Min-CL and 75.3% CLV) and specificity (66.7% Min-CL and 76.9% CLV) in predicting ESA with an ablation response. CONCLUSIONS ESA correlate with rapidity and organization markers. Further work is needed to clarify any role for spectral analysis in prioritizing driver ablation.
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Affiliation(s)
| | | | - Emily Keating
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,QUML
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Getting in Contact With Atrial Fibrillation or Not. JACC Clin Electrophysiol 2020; 6:182-184. [DOI: 10.1016/j.jacep.2019.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/17/2019] [Indexed: 11/19/2022]
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Honarbakhsh S, Schilling RJ, Finlay M, Keating E, Ullah W, Hunter RJ. STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping. J Cardiovasc Electrophysiol 2019; 30:2694-2703. [PMID: 31552697 PMCID: PMC6916564 DOI: 10.1111/jce.14201] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/05/2019] [Accepted: 09/21/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The optimal way to map localized drivers in persistent atrial fibrillation (AF) remains unclear. The objective of the study was to apply a novel vector mapping approach called Stochastic Trajectory Analysis of Ranked signals (STAR) in AF. METHODS AND RESULTS Patients having persistent AF ablation were included. Early sites of activation (ESA) identified on global STAR maps created with basket catheters were used to guide AF ablation post-pulmonary vein isolation (PVI). All patients also had sequential STAR maps created with ≥10 PentaRay recordings of 30 seconds. These were validated offline in their ability to identify the ESA targeted with a study-defined ablation response (AF termination or cycle length [CL] slowing of ≥30 ms). Thirty-two patients were included in whom 92 ESA were identified on the global STAR maps, with 73 of 83 targeted sites demonstrating an ablation response (24 AF termination and 49 CL slowing). Sixty-one out of 73 (83.6%) ESA were also identified on the sequential STAR maps. These showed greater consistency (P < .001), were seen pre- and post-PVI (P < .001) and were more likely to be associated with AF termination on ablation (P = .007). The sensitivity and specificity of sequential mapping for the detection of ESA with an ablation response was 84.9% (95% confidence interval [CI] = 74.6-92.2) and 90.0% (95% CI = 55.5-99.8), respectively. During a follow-up of 19.4 ± 3.7 months, 28 (80%) patients were free from AF/atrial tachycardia. CONCLUSIONS STAR mapping consistently identified ESA in all patients and the ablation response was compatible with ESA being driver sites. Mechanistically important ESA were successfully identified using sequential recordings.
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Affiliation(s)
- Shohreh Honarbakhsh
- Electrophysiology department, The Barts Heart Centre, London, United Kingdom
| | - Richard J Schilling
- Electrophysiology department, The Barts Heart Centre, London, United Kingdom
| | - Malcolm Finlay
- Electrophysiology department, The Barts Heart Centre, London, United Kingdom
| | - Emily Keating
- Electrophysiology department, The Barts Heart Centre, London, United Kingdom
| | - Waqas Ullah
- Electrophysiology department, The Barts Heart Centre, London, United Kingdom
| | - Ross J Hunter
- Electrophysiology department, The Barts Heart Centre, London, United Kingdom
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Vandersickel N, Van Nieuwenhuyse E, Van Cleemput N, Goedgebeur J, El Haddad M, De Neve J, Demolder A, Strisciuglio T, Duytschaever M, Panfilov AV. Directed Networks as a Novel Way to Describe and Analyze Cardiac Excitation: Directed Graph Mapping. Front Physiol 2019; 10:1138. [PMID: 31551814 PMCID: PMC6746922 DOI: 10.3389/fphys.2019.01138] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/19/2019] [Indexed: 12/31/2022] Open
Abstract
Networks provide a powerful methodology with applications in a variety of biological, technological and social systems such as analysis of brain data, social networks, internet search engine algorithms, etc. To date, directed networks have not yet been applied to characterize the excitation of the human heart. In clinical practice, cardiac excitation is recorded by multiple discrete electrodes. During (normal) sinus rhythm or during cardiac arrhythmias, successive excitation connects neighboring electrodes, resulting in their own unique directed network. This in theory makes it a perfect fit for directed network analysis. In this study, we applied directed networks to the heart in order to describe and characterize cardiac arrhythmias. Proof-of-principle was established using in-silico and clinical data. We demonstrated that tools used in network theory analysis allow determination of the mechanism and location of certain cardiac arrhythmias. We show that the robustness of this approach can potentially exceed the existing state-of-the art methodology used in clinics. Furthermore, implementation of these techniques in daily practice can improve the accuracy and speed of cardiac arrhythmia analysis. It may also provide novel insights in arrhythmias that are still incompletely understood.
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Affiliation(s)
- Nele Vandersickel
- Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | | | - Nico Van Cleemput
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Jan Goedgebeur
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
- Computer Science Department, University of Mons, Mons, Belgium
| | - Milad El Haddad
- Ghent University Hospital Heart Center, Ghent University, Ghent, Belgium
| | - Jan De Neve
- Department of Data Analysis, Ghent University, Ghent, Belgium
| | - Anthony Demolder
- Ghent University Hospital Heart Center, Ghent University, Ghent, Belgium
| | | | - Mattias Duytschaever
- Ghent University Hospital Heart Center, Ghent University, Ghent, Belgium
- Cardiology Department, AZ Sint-Jan, Bruges, Belgium
| | - Alexander V. Panfilov
- Department of Physics and Astronomy, Ghent University, Ghent, Belgium
- Laboratory of Computational Biology and Medicine, Ural Federal University, Ekaterinburg, Russia
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Honarbakhsh S, Hunter RJ, Ullah W, Keating E, Finlay M, Schilling RJ. Ablation in Persistent Atrial Fibrillation Using Stochastic Trajectory Analysis of Ranked Signals (STAR) Mapping Method. JACC Clin Electrophysiol 2019; 5:817-829. [PMID: 31320010 DOI: 10.1016/j.jacep.2019.04.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to demonstrate that a stochastic vector-based mapping approach could guide ablation of atrial fibrillation (AF) drivers as evidenced by ablation response and long-term follow-up outcomes. BACKGROUND The optimal method for mapping and ablation of AF drivers is yet to be defined. METHODS Patients undergoing persistent AF ablation were recruited. Patients underwent pulmonary vein isolation (PVI) with further ablation guided by the stochastic trajectory analysis of ranked signals (STAR) mapping method. The proportion of the time an electrode's activation was seen to precede its neighboring electrodes activation was used to determine early sites of activation (ESA). A positive ablation response at ESA was defined as AF termination or cycle length slowing of ≥30 ms. Clinical outcome was defined as recurrence of AF/atrial tachycardia (AT) during a follow-up of 12 months. RESULTS Thirty-five patients were included (AF duration of 14.4 ± 5.3 months). After PVI, an average of 2.6 ± 0.8 ESA were ablated per patient with study-defined ablation response achieved in all patients. Of the 86 STAR maps created post-PVI, the same ESA was identified on 73.8 ± 26.1% of maps. ESA that resulted in AF termination were more likely to be identified on both pre- and post-PVI maps than those associated with cycle length slowing (23 of 24 vs. 16 of 49; p < 0.001). During a follow-up of 18.5 ± 3.7 months, 28 (80%) patients were free from AF/AT. CONCLUSIONS The ablation response at ESA suggests they may be drivers of AF. Ablation guided by STAR mapping produced a favorable clinical outcome and warrants testing through a randomized controlled trial. (Identification, Electro-mechanical Characterisation and Ablation of Driver Regions in Persistent Atrial Fibrillation [STAR MAPPING]; NCT02950844).
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Affiliation(s)
- Shohreh Honarbakhsh
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Waqas Ullah
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Emily Keating
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Richard J Schilling
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom.
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