Electrocardiographic Imaging as Preoperative Tool in Persistent and Long-Standing Persistent Atrial Fibrillation: A...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Imaging

Background:

• Surgical ablation for atrial fibrillation (AF) often lacks preoperative electrophysiological imaging.
• Understanding AF mechanisms is crucial for effective treatment planning.

Purpose of the Study:

• To investigate non-invasive surface mapping as a preoperative tool for exploring AF electrophysiology.
• To identify potential mechanisms and patterns in persistent and long-standing persistent AF.

Main Methods:

• Prospective observational study of 51 cardiac surgery candidates without prior ablation.
• Bi-atrial epicardial activation sequences obtained using electrocardiographic imaging.
• Hierarchical clustering analyzed data to identify patient clusters based on electrophysiological drivers.

Main Results:

• All patients exhibited bi-atrial electrophysiological abnormalities.
• Rotors were predominantly found in the right atrium, pulmonary veins, and left atrial backwall.
• Larger left atrial size correlated with fewer rotors; AF duration did not correlate with rotor or focal activity number.

Conclusions:

• Non-invasive mapping identified underlying electrophysiological mechanisms in all AF patients, showing consistent bi-atrial involvement.
• Lower rotor counts in larger atria/longer AF duration may indicate fibrosis.
• Preoperative mapping shows potential to enhance procedural planning and understanding of AF electrophysiology.