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Rossi P, Cauti FM, Polselli M, Magnocavallo M, Niscola M, Fanti V, Limite LR, Evangelista A, Bellisario A, De Paolis R, Facchetti S, Quaglione R, Piccirillo G, Bianchi S. Ablation of persistent atrial fibrillation based on atrial electrogram duration map: methodology and clinical outcomes from the AEDUM pilot study. J Interv Card Electrophysiol 2024:10.1007/s10840-023-01721-7. [PMID: 38206451 DOI: 10.1007/s10840-023-01721-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Catheter ablation of persistent atrial fibrillation (PsAF) represents a challenge for the electrophysiologist and there are still divergences regarding the best ablative approach to adopt. Create a new map of the duration of atrial bipolar electrograms (Atrial Electrogram DUration Map, AEDUM) to recognize a functional substrate during sinus rhythm and guide a patient-tailored ablative strategy for PsAF. METHODS Forty PsAF subjects were assigned in a 1:1 ratio to either for PVI alone (Group B1) or PVI+AEDUM areas ablation (Group B2). A cohort of 15 patients without AF history undergoing left-sided accessory pathway ablation was used as a control group (Group A). In all patients, voltage and AEDUM maps were created during sinus rhythm. The minimum follow-up was 12 months, with rhythm monitoring via 48-h ECG Holter or by implantable cardiac device. RESULTS Electrogram (EGM) duration was higher in Group B than in Group A (49±16.2ms vs 34.2±3.8ms; p-value<0.001). In Group B the mean cumulative AEDUM area was 21.8±8.2cm2; no difference between the two subgroups was observed (22.3±9.1cm2 vs 21.2±7.2cm2; p-value=0.45). The overall bipolar voltage recorded inside the AEDUM areas was lower than in the remaining atrial areas [median: 1.30mV (IQR: 0.71-2.38mV) vs 1.54mV (IQR: 0.79-2.97mV); p-value: <0.001)]. Low voltage areas (<0.5mV) were recorded in three (7.5%) patients in Group B. During the follow-up [median 511 days (376-845days)] patients who underwent PVI-only experienced more AF recurrence than those receiving a tailored approach (65% vs 35%; p-value= 0.04). CONCLUSIONS All PsAF patients exhibited AEDUM areas. An ablation approach targeting these areas resulted in a more effective strategy compared with PVI only.
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Affiliation(s)
- Pietro Rossi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy.
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - Marco Polselli
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - Michele Magnocavallo
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - Marta Niscola
- Abbott Medical, Via Paracelso 20, 20864, Agrate Brianza, Italy
| | - Veronica Fanti
- Abbott Medical, Via Paracelso 20, 20864, Agrate Brianza, Italy
| | | | - Antonietta Evangelista
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | | | | | | | - Raffaele Quaglione
- Department of Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185, Rome, Italy
| | - Gianfranco Piccirillo
- Department of Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185, Rome, Italy
| | - Stefano Bianchi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
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Silva Garcia E, Lobo-Torres I, Fernández-Armenta J, Penela D, Fernandez-Garcia M, Gomez-Lopez A, Soto-Iglesias D, Fernández-Rivero R, Vazquez-Garcia R, Acosta J, Bisbal F, Cano-Calabria L, Berruezo A. Functional mapping to reveal slow conduction and substrate progression in atrial fibrillation. Europace 2023; 25:euad246. [PMID: 37961921 PMCID: PMC10644200 DOI: 10.1093/europace/euad246] [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: 05/11/2023] [Accepted: 08/11/2023] [Indexed: 11/15/2023] Open
Abstract
AIMS The aim of our study was to analyse the response to short-coupled atrial extrastimuli to identify areas of hidden slow conduction (HSC) and their relationship with the atrial fibrillation (AF) phenotype. METHODS AND RESULTS Twenty consecutive patients with paroxysmal AF and persistent AF (10:10) underwent the first pulmonary vein isolation procedure. Triple short-coupled extrastimuli were delivered in sinus rhythm (SR), and the evoked response was analysed: sites exhibiting double or highly fragmented electrograms (EGM) were defined as positive for HSC (HSC+). The delta of the duration of the bipolar EGM was analysed, and bipolar EGM duration maps were built. High-density maps were acquired using a multipolar catheter during AF, SR, and paced rhythm. Spatial co-localization of HSC+ and complex fractionated atrial EGMs (CFAE) during AF was evaluated. Persistent AF showed a higher number and percentage of HSC+ than paroxysmal AF (13.9% vs. 3.3%, P < 0.001). The delta of EGM duration was 53 ± 22 ms for HSC+ compared with 13 ± 11 (10) ms in sites with negative HSC (HSC-) (P < 0.001). The number and density of HSC+ were lower than CFAE during AF (19 vs. 56 per map, P < 0.001). The reproducibility and distribution of HSC+ in repeated maps were superior to CFAE (P = 0.19 vs. P < 0.001). Sites with negative and positive responses showed a similar bipolar voltage in the preceding sinus beat (1.65 ± 1.34 and 1.48 ± 1.47 mV, P = 0.12). CONCLUSION Functional mapping identifies more discrete and reproducible abnormal substrates than mapping during AF. The HSC+ sites in response to triple extrastimuli are more frequent in persistent AF than in paroxysmal AF.
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Affiliation(s)
- Etel Silva Garcia
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Ivan Lobo-Torres
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | - Diego Penela
- Teknon Medical Center, Heart Institute, Barcelona, Spain
| | | | - Andrea Gomez-Lopez
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | | | | | - Juan Acosta
- Department of Cardiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Felipe Bisbal
- Institut del Cor (iCor), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Lucas Cano-Calabria
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
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