Interaction between pulmonary vein reconnection and extra-pulmonary vein AF drivers: a dipole charge density mapping study
I A Minciuna, R B Gagyi, T Szili-TorokAbstract
Background
Pulmonary vein isolation (PVI) has been for many years the cornerstone for catheter ablation (CA) of paroxysmal atrial fibrillation (AF). However, in patients with persistent AF, the results of PVI alone remain suboptimal, suggesting a role for non-pulmonary vein (extra-PV) sources in arrhythmia maintenance. Although there is increasing evidence that supports targeting AF-driving sources for persistent AF, there is currently limited data about the interaction between the PVs and extra-PV sources and the effect of PVI on extra-PV sources is poorly understood. The dipole charge density mapping (DCDM) system enables high-resolution visualization of AF-driving sources, but the relationship between PV reconnection and extra-PV source behavior remains incompletely understood.
Objective
To evaluate the interaction between PV reconnection and the characteristics of extra-PV sources in patients undergoing repeat ablation for persistent AF using DCDM.
Methods
We analyzed 26 consecutive patients (mean age 61.8 ± 8.8 years) who underwent repeat radiofrequency CA for persistent AF guided by DCDM. PV reconnection was defined by the presence of PV potentials. Extra-PV sources were classified as focal, local rotational, or local irregular activity. Source distribution, mechanism, and ablation strategy were compared between patients with and without PV reconnection.
Results
PV reconnection was observed in 17 patients (65.3%). Extra-PV sources were predominantly located on the anterior (65%) and posterior (73%) left atrial walls, independent of PV reconnection status. The most frequent adjunctive ablation was an anterior line (35.2% vs. 55.5%, p = 0.3). Patients with PV reconnection demonstrated a significantly higher prevalence of local rotational activity (80% vs. 33%, p = 0.02), while rates of focal (60% vs. 66.6%) and irregular activity (53.3% vs. 66.6%) were similar between groups.
Conclusion
Our data suggests that there is an association between PV reconnection and local rotational activity mapped using DCDM in patients undergoing repeated ablation for persistent AF.