Background: Catheter ablation (CA) remains challenging due to suboptimal success rates in persistent atrial fibrillation (AF). Existing mapping technologies cannot reliably distinguish sources in this patient population. Recently, the novel electrographic flow (EGF) mapping system was developed using a modified Horn-Schunk optical flow algorithm to detect and quantify patterns of electrical wavefront propagation in the atria.…
To evaluate whether AF source activity identified by EGF mapping is reproducible over procedures separated by ≥ 3 months.
Correlate EGFC with regional bipolar voltage values in patients during AF and sinus rhythm (SR).
Characterize EGF patterns of electrical activation across atrial endocardium during sinus rhythm (SR) v. during AF driven by active EGF-identified sources.
Evaluate EGF patterns and metrics that may be used to successfully differentiate endocardial activations of various atrial arrhythmias.
Evaluate PFA lesions created using an innovative catheter design combining focal, linear and pulmonary vein (PV) ablation.
Determine relationship between EGFC and AF recurrence. Propose a phenotyping framework for treatment and prognosis based on functional mechanisms as described by EGF.
Examine the success of a PVI-only ablation strategy for a redo PeAF/long-standing PeAF population.
Examine patterns of FC between the LA and RA among all-comers with AF. Methods Data was prospectively collected from patients with paroxysmal, persistent, and long-standing persistent AF, who underwent EGF mapping with a 64-electrode basket catheter and catheter ablation for AF. For each patient, a series of 1 minute EGF recordings were taken post-PVI in multiple standardized locations in both LA and RA to optimize endocardial coverage. Recordings always occurred prior to any EGF-identified source ablations, if clinically relevant sources were detected post-PVI. Mean FC from these recordings were taken and averaged per recording location and then averaged per atrium.
Ablation strategies remain poorly defined for persistent atrial fibrillation (AF) patients with recurrence despite intact pulmonary vein isolation (PVI). As the ability to perform durable PVI improves, the need for advanced mapping to identify extra-PV sources of AF becomes increasingly evident. Multiple mapping technologies attempt to localize these self-sustained triggers and/or drivers responsible for initiating and/or maintaining AF; however, current approaches suffer from technical limitations. Electrographic flow (EGF) mapping is a novel mapping method based on well-established principles of optical flow and fluid dynamics. It enables the full spatiotemporal reconstruction of organized wavefront propagation within the otherwise chaotic and disorganized electrical conduction of AF. Given the novelty of EGF mapping and relative unfamiliarity of most clinical electrophysiologists with the mathematical principles powering the EGF algorithm, this paper provides an in-depth explanation of the technical/mathematical foundations of EGF mapping and demonstrates clinical applications of EGF mapping data and analyses.