Right Atrial Complexity Evolves With Stepwise Left-Sided Persistent Atrial Fibrillation Substrate Ablation and...

Area of Science:

• Electrophysiology
• Cardiac Arrhythmias
• Medical Device Technology

Background:

• Identifying patients with persistent atrial fibrillation (AF) who benefit from limited versus extensive ablation is challenging.
• Substrate modification aims to improve ablation success rates in persistent AF.
• Dynamic electrogram characteristics may offer insights into ablation outcomes.

Purpose of the Study:

• To investigate the relationship between modified stepwise AF substrate ablation outcomes and dynamic electrogram characteristics.
• To assess the predictive value of electrogram complexity gradients for AF ablation success.
• To guide ablation strategies by monitoring electrogram changes during the procedure.

Main Methods:

• Seventy patients with persistent AF undergoing ablation were studied.
• Electrograms from the right atrium (RA) and coronary sinus (CS) were recorded during AF.
• Dominant frequency (DF) and sample entropy (SampEn) were measured at baseline and post-ablation steps.

Main Results:

• Lower RA SampEn and CS DF at baseline predicted successful ablation (sABL).
• A positive RA-to-CS SampEn gradient predicted ablation failure.
• A negative RA-to-CS SampEn gradient at baseline correlated with freedom from AF at 24 months.

Conclusions:

• Electrogram complexity gradients (RA vs. CS) are associated with AF ablation outcomes.
• These gradients can monitor ablation effectiveness and inform decisions on additional substrate modification.
• Utilizing electrogram gradients may optimize treatment for persistent AF patients.