Author + information
- Received February 28, 2019
- Revision received April 23, 2019
- Accepted April 24, 2019
- Published online May 7, 2019.
- S. Honarbakhsh, MRCP BSc,
- R.J. Hunter, FESC PhD,
- W. Ullah, MRCP PhD,
- E. Keating, BAppSc IBHRE CCDS,
- M. Finlay, BA(Oxon) MRCP PhD and
- R.J. Schilling, MRCP FESC MD∗ ()
- ↵∗Corresponding Author: Prof Richard J Schilling, MRCP MD Barts Heart Centre, Barts Health NHS trust West Smithfield EC1A 7BE Fax: +44 207 573 8838.
Background The optimal method for mapping and ablation of atrial fibrillation (AF) drivers is yet to be defined. The aim was to demonstrate that a stochastic vector based mapping approach could guide ablation of AF drivers as evidenced by ablation response and long-term follow-up outcomes.
Method Patients undergoing persistent AF ablation were recruited. Patients underwent pulmonary vein isolation (PVI) with further ablation guided by the Stochastic Trajectory of Ranked Signals (STAR) mapping method. The proportion of the time an electrode’s activation was seen to precede its neighboring electrodes activation was used to determine early sites of activation (ESA). A positive ablation response at ESA was defined as AF termination or cycle length (CL) slowing of ≥30ms. Clinical outcome was defined as recurrence of atrial tachycardia (AT)/AF during a follow-up of 12 months.
Results Thirty-five patients were included (AF duration of 14.4±5.3 months). After PVI an average of 2.6±0.8 ESA were ablated per patient with study-defined ablation response achieved in all patients. Out of the 86 STAR maps created post-PVI, the same ESA was identified on 73.8±26.1% of maps. ESA that resulted in AF termination were more likely to be identified on both pre- and post-PVI maps than those associated with CL slowing (23/24 vs. 16/49; p<0.001). During a follow-up of 18.5±3.7 months, 28 (80%) patients were free from AT/AF.
Conclusions The ablation response at ESA suggests they may be drivers of AF. Ablation guided by STAR mapping produced a favorable clinical outcome and warrants testing through a randomized controlled trial.
FUNDING: A Project Grant from the British Heart Foundation (PG/16/10/32016) funded this work.
DISCLOSURES: Prof. Schilling has received speaker and travel grants from Biosense Webster and research grants from Biosense Webster and Boston Scientific. Dr Hunter has received travel grants from Medtronic.
FUNDING British Heart Foundation project grant (PG/16/10/32016).
- Received February 28, 2019.
- Revision received April 23, 2019.
- Accepted April 24, 2019.