IntroductionCatheter ablation of persistent AF has not been consistently successful ethical nutrients mega magnesium powder citrus 450g in terminating AF or preventing arrhythmia recurrences.Non-invasive Electrocardiographic Imaging (ECGI) can help to understand recurrences by mapping the mechanisms of pre-ablation AF and comparing them with the patterns of recurrent arrhythmias in the same patient.MethodsSeventeen persistent AF patients underwent ECGI before their first catheter ablation.
Time-domain activation maps and phase progression maps were obtained on the bi-atrial epicardium.Location of arrhythmogenic drivers were annotated on the bi-atrial anatomy.Activation and phase movies were examined to understand the wavefront dynamics during AF.
Eight patients recurred within 12 months of ablation and underwent a follow-up ECGI.Driver locations and movies were compared for pre- and post-ablation AF.ResultsA total of 243 focal drivers were mapped during pre-ablation AF.
62% of the drivers were mapped in the left atrium (LA).The pulmonary vein region harbored most of the drivers (43%).35% of the drivers were mapped in the right atrium (RA).
59% (10/17) and 53% (9/17) of patients had repetitive sources in the left pulmonary veins (LPV) and left atrial appendage (LAA), and the lower half of RA, respectively.All patients had focal drivers.29% (5/17) of patients had macro-reentry waves.
24% (4/17) of patients had rotors.Activation patterns during persistent AF motovox scooter parts varied from single macro-reentry to complex activity with multiple simultaneous wavefronts in both atria, resulting in frequent wave collisions.A total of 76 focal driver activities were mapped in 7/8 patients during recurrence.
59% of the post-ablation AF drivers were mapped in the LA.The pulmonary vein region harbored 50% of total drivers.39% of sources were mapped in the RA.
AF complexity remained similar post-ablation.58% (44/76) of pre-ablation sources persisted during recurrence.38% (3/8) of patients had macro-reentry and one patient had rotors.
ConclusionECGI provides patient-specific information on mechanisms of persistent AF and recurrent arrhythmia.More than half pre-ablation sources repeated during post-ablation recurrence.This study provides direct evidence for drivers that persist days and months after the ablation procedure.
Patient-tailored bi-atrial ablation is needed to successfully target persistent AF and prevent recurrence.ECGI can potentially predict recurrence and assist in choice of therapy.