Po-04-031 spatiotemporal stability of persistent atrial fibrillation sources: stable source or disease progression?

Catheter ablation (CA) for persistent atrial fibrillation (AF) is challenging and is associated with suboptimal long-term outcomes. A major limitation of standard approaches to treat persistent AF is their predominantly empirical nature. Substrate ablation techniques to improve outcomes have been the subject of many clinical trials. Increasing evidence supports the existence of spatially localized extra pulmonary-vein (PV) sources that maintain persistent AF. Electrographic flow mapping (EGF), CardioInsight and dipole charge density mapping (AcQMap) are three global (atrial) chamber mapping (GACM) based technologies specifically developed to identify AF sources. In this case-series we aimed to assess the spatiotemporal stability of extra-PV sources in patients with persistent AF. We present a series of patients with persistent AF who underwent an initial and at least one redo CA procedure utilizing GACM. The following GACM systems were used: CardioInsight, EGF, and AcQMap, in the following combinations: AcQMap-AcQMap (1 patient), AcQMap-EGF (1 patient), EGF-AcQMap (1 patient), CardioInsight-AcQMap (1 patient), EGF-EGF (3 patients). We reviewed maps and analyzed the location of sources using the 3D mapping system. Spatiotemporal stability was defined as the presence of an AF source of identical location on available maps during the initial and the redo procedure. Seven patients were identified (mean age 62±9 years, 57% male). In 3 patients (43%) localization of AF sources mapped at the repeat procedure corresponded with the localization of sources mapped during the index procedure. In two patient no sources were identified during the second procedure. In the remaining 2 patients the localization of sources was detected at different locations. The figure shows sources with same localization on two different maps acquired with the EGF and the AcQMap system. Spatiotemporal stability of AF sources mapped using GACM systems can be confirmed, however novel sources are found during the repeated procedure suggesting disease progression.