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Electrogram Morphology Recurrence for Mapping Persistent Atrial Fibrillation: Initial vs Redo Catheter Ablation.

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Summary
This summary is machine-generated.

Electrogram (EGM) morphology recurrence (EMR) mapping reveals activation patterns in persistent atrial fibrillation (AF). This study compared EMR in the left and right atria during first vs. redo ablation procedures.

Keywords:
ablationatrial fibrillationelectrogramelectrogram morphology recurrencemapping

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • Persistent atrial fibrillation (AF) ablation requires precise identification of arrhythmogenic drivers.
  • Electrogram (EGM) morphology recurrence (EMR) mapping quantifies activation consistency, expected to be high near AF drivers.

Purpose of the Study:

  • To compare EMR characteristics in the left atrium (LA) and right atrium (RA).
  • To evaluate EMR in patients undergoing first-time versus repeat ablation for persistent AF.

Main Methods:

  • Multisite LA/RA mapping was performed in 42 patients (32 first ablation, 10 redo ablation).
  • EGM signals were cross-correlated to identify the most recurrent morphology, its frequency (Rec%), and recurrence cycle length (CLR).

Main Results:

  • Minimum CLR was shorter in the LA compared to the RA (P=0.0005) in first-time ablation patients.
  • The shortest CLR was located in the LA in 84% of first-time ablation patients versus 50% in redo cases (P=0.04).
  • Pulmonary veins (PVs) were identified as the shortest CLR site in 59% of initial ablation patients.

Conclusions:

  • EMR mapping effectively identifies pulmonary veins as critical sites for AF maintenance in a majority of initial ablation patients.
  • Most atrial sites exhibit low recurrence, suggesting they are not primary drivers of AF.
  • EMR offers a novel, robust method for assessing activation consistency and directionality in the atria.