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STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping.

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?

SUBMITTER: Honarbakhsh S

PROVIDER: S-EPMC6916564 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping.

Honarbakhsh Shohreh S Schilling Richard J RJ Finlay Malcolm M Keating Emily E Ullah Waqas W Hunter Ross J RJ

Journal of cardiovascular electrophysiology 20191003 12

<h4>Introduction</h4>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.<h4>Methods and results</h4>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) ...[more]

PMID: 31552697

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Project description:Background Atrial fibrillation (AF) driver mechanisms are obscured to clinical multielectrode mapping approaches that provide partial, surface-only visualization of unstable 3-dimensional atrial conduction. We hypothesized that transient modulation of refractoriness by pharmacologic challenge during multielectrode mapping improves visualization of hidden paths of reentrant AF drivers for targeted ablation. Methods and Results Pharmacologic challenge with adenosine was tested in ex vivo human hearts with a history of AF and cardiac diseases by multielectrode and high-resolution subsurface near-infrared optical mapping, integrated with 3-dimensional structural imaging and heart-specific computational simulations. Adenosine challenge was also studied on acutely terminated AF drivers in 10 patients with persistent AF. Ex vivo, adenosine stabilized reentrant driver paths within arrhythmogenic fibrotic hubs and improved visualization of reentrant paths, previously seen as focal or unstable breakthrough activation pattern, for targeted AF ablation. Computational simulations suggested that shortening of atrial refractoriness by adenosine may (1) improve driver stability by annihilating spatially unstable functional blocks and tightening reentrant circuits around fibrotic substrates, thus unmasking the common reentrant path; and (2) destabilize already stable reentrant drivers along fibrotic substrates by accelerating competing fibrillatory wavelets or secondary drivers. In patients with persistent AF, adenosine challenge unmasked hidden common reentry paths (9/15 AF drivers, 41±26% to 68±25% visualization), but worsened visualization of previously visible reentry paths (6/15, 74±14% to 34±12%). AF driver ablation led to acute termination of AF. Conclusions Our ex vivo to in vivo human translational study suggests that transiently altering atrial refractoriness can stabilize reentrant paths and unmask arrhythmogenic hubs to guide targeted AF driver ablation treatment.

Dataset Information

STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping.

Publications

STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping.

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