Wavefront Field Mapping Reveals a Physiologic Network Between Drivers Where Ablation Terminates Atrial Fibrillation

Area of Science:

• Cardiology
• Electrophysiology
• Medical Physics

Background:

• Localized drivers are proposed mechanisms for persistent atrial fibrillation (AF).
• The fluctuating nature and ablation resistance of drivers have made their role controversial.
• Wavefront field mapping was used to investigate driver interactions in persistent AF.

Purpose of the Study:

• To test the hypothesis that concurrent AF drivers interact.
• To explain fluctuating driver control and ablation outcomes.
• To identify effective ablation targets in persistent AF.

Main Methods:

• Recruited 54 patients with persistent AF terminated by ablation.
• Analyzed unipolar electrograms using 64-pole baskets to reconstruct activation times.
• Mapped propagation vectors and created phase maps to identify drivers.

Main Results:

• Identified 3 patterns of 4.0±2.1 spatially anchored rotational or focal sites in AF.
• Type I (single) and Type II (paired) drivers were ablated, terminating AF.
• Type III (3-5 interacting drivers) required more ablation, indicating complex control.

Conclusions:

• Persistent AF involves a network of interacting, spatially anchored drivers.
• These drivers fluctuate and control varying atrial areas.
• Further research is needed to determine if drivers controlling larger areas are better ablation targets.