STABLE ROTORS AND FOCAL SOURCES FOR HUMAN ATRIAL FIBRILLATION LIE WIDELY IN BOTH ATRIA
S.M. Narayan, V. Swarup; J.C. Daubert, J. Day, K. Ellenbogen, J. Hummel, R.C. Kowal, D.E. Krummen, J. M. Miller, V.Y. Reddy, K. Shivkumar, J.S. Steinberg, K. Wheelan
Arizona Heart Rhythm Center, Phoenix, AZ, Duke University Medical Center, Durham, NC, Intermountain Heart Institute, Murray, UT, VCU Health System, Richmond, VA; Ohio State University, Columbus, OH, HeartPlace/Baylor University Medical Center, Dallas, TX; UCSD / VA San Diego Medical Center, San Diego, CA, Krannert Institute of Cardiology, Indianapolis, IN, Mt. Sinai Hospital, New York, NY, UCLA Cardiac Arrhythmia Center, Los Angeles, CA, Valley Health System, Ridgewood, NJ,USA
Introduction: Clinical atrial fibrillation (AF) has been shown to be sustained by stable rotors or focal impulses, where Focal Impulse and Rotor Map (FIRM)-guided ablation improves patient outcomes. We studied source locations in a large multicenter prospective study.
Methods: : We mapped AF in 210 patients (28% paroxysmal) using 64 pole baskets in both atria, and analyzed AF using RhythmViewTM (Topera Inc). AF sources on FIRM-maps were related to patient-specific three dimensional electroanatomic map locations (NavX) validated by fluoroscopy. FIRM-guided ablation was performed in n=132 consecutive patients.
Results: We identified stable sources in 129/130 mapped patients (99.2%), for 2.6±1.2 sources/patient. A total of 341 sources were identified: 71.0% in left and 29.0% right atria (p<-0.05). Sources were widely distributed (figure), with little predilection (p=NS). Notably, 30-40% sources tracked wide-area PV ablation lines, an additional 15-20% on the posterior wall and ~10% at the left atrial roof.
Conclusions: Stable rotors and focal AF sources lie widely within both atria. AF source distributions are very similar to the CONFIRM trial, and are consistent with documented success rates of different anatomic AF ablation lines. These results motivate patient-tailored AF ablation at sources.
