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Related Experiment Video

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High-Resolution Endocardial and Epicardial Optical Mapping in a Sheep Model of Stretch-Induced Atrial Fibrillation
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STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential

Shohreh Honarbakhsh1, Richard J Schilling1, Malcolm Finlay1

  • 1Electrophysiology department, The Barts Heart Centre, London, United Kingdom.

Journal of Cardiovascular Electrophysiology
|September 26, 2019
PubMed
Summary

Stochastic Trajectory Analysis of Ranked signals (STAR) mapping effectively identifies early activation sites in persistent atrial fibrillation (AF). This novel approach guides ablation, leading to successful outcomes and sustained freedom from AF.

Keywords:
atrial fibrillationatrial tachycardiacatheter ablationdriversmapping

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Persistent atrial fibrillation (AF) ablation requires precise identification of localized drivers.
  • Current mapping techniques for identifying these drivers in AF have limitations.

Purpose of the Study:

  • To evaluate a novel vector mapping approach, Stochastic Trajectory Analysis of Ranked signals (STAR), for identifying early activation sites (ESA) in persistent AF.
  • To assess the efficacy of STAR-guided ablation in patients with persistent AF.

Main Methods:

  • Applied global and sequential STAR mapping using basket catheters in patients undergoing persistent AF ablation.
  • Identified early sites of activation (ESA) on STAR maps to guide ablation post-pulmonary vein isolation (PVI).
  • Validated the ability of sequential STAR maps to identify ESA targeted for ablation, assessing ablation response (AF termination or cycle length slowing).

Main Results:

  • STAR mapping successfully identified 92 ESA in 32 patients.
  • Ablation targeting identified ESA resulted in a positive response in 73 out of 83 sites (87.9%).
  • Sequential STAR maps showed high consistency (83.6%) in identifying ESA and were more likely to be associated with AF termination (P=.007).
  • The sensitivity and specificity of sequential mapping for detecting effective ESA were 84.9% and 90.0%, respectively.
  • At follow-up (19.4 ± 3.7 months), 80% of patients were free from AF/atrial tachycardia.

Conclusions:

  • STAR mapping consistently identifies early activation sites (ESA) in persistent AF, supporting their role as driver sites.
  • Sequential STAR recordings effectively identify mechanistically important ESA, leading to successful ablation outcomes.
  • STAR mapping represents a promising tool for guiding AF ablation, improving patient outcomes.