Electrophysiological Characteristics of Atrial Fibrillation Trigger Sites During Ongoing Atrial Fibrillation Using...

Area of Science:

• Electrophysiology
• Cardiac Arrhythmias
• Medical Device Technology

Background:

• Atrial fibrillation (AF) triggers are known, but their behavior during sustained AF is unclear.
• Understanding local electrogram properties at trigger sites is crucial for AF management.

Purpose of the Study:

• To characterize local electrogram properties at AF trigger sites during ongoing AF.
• To compare these properties with non-trigger sites using an ultra-high-resolution mapping system.

Main Methods:

• Retrospective analysis of 45 patients with pulmonary vein (PV) or superior vena cava (SVC) triggers.
• Assessment of local cycle length (L-CL) and duty cycle (DC) using automated mapping.
• Comparison of electrogram parameters between trigger veins and other cardiac regions.

Main Results:

• Trigger veins showed significantly shorter minimum L-CL (median 119 ms) compared to non-trigger PVs, left atrium, SVC, and right atrium.
• Minimum L-CL was the strongest predictor of AF trigger sites (AUC 0.856).
• Duty cycle parameters were comparable across trigger veins, non-trigger PVs, and the left atrium.

Conclusions:

• AF trigger sites are characterized by shorter minimum L-CL during AF, suggesting transient rapid activity.
• These findings offer mechanistic insights into AF trigger behavior.
• This may aid in identifying AF triggers when conventional methods are inconclusive.