Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Ablacon, Inc., Wheat Ridge, Colorado, USA.
J Cardiovasc Electrophysiol. 2021 Aug;32(8):2148-2158. doi: 10.1111/jce.15115. Epub 2021 Jun 7.
Electrographic flow (EGF) mapping is a method to detect action potential sources within the atria. In a double-blinded retrospective study we evaluated whether sources detected by EGF are related to procedural outcome.
EGF maps were retrospectively generated using the Ablamap® software from unipolar data recorded with a 64-pole basket catheter from patients who previously underwent focal impulse and rotor modulation-guided ablation. We analyzed patient outcomes based on source activity (SAC) and variability. Freedom from atrial fibrillation (AF) was defined as no recurrence of AF, atypical flutter or atrial tachycardia at the follow-up visits.
EGF maps were from 123 atria in 64 patients with persistent or long-standing persistent AF. Procedural outcome correlation with SAC peaked at >26%. S-type EGF signature (source-dependent AF) is characterized by stable sources with SAC > 26% and C-type (source-independent AF) is characterized by sources with SAC ≤ 26%. Cases with AF recurrence at 3-, 6-, or 12-month follow-up showed a median final SAC 34%; while AF-free patients had sources with significantly lower median final SAC 21% (p = .0006). Patients with final SAC and Variability above both thresholds had 94% recurrence, while recurrence was only 36% for patients with leading source SAC and variability below threshold (p = .0001). S-type EGF signature post-ablation was associated with an AF recurrence rate 88.5% versus 38.1% with C-type EGF signature.
EGF mapping enables the visualization of active AF sources. Sources with SAC > 26% appear relevant and their presence post-ablation correlates with high rates of AF recurrence.
电图流（EGF）图是一种检测心房内动作电位源的方法。在一项双盲回顾性研究中，我们评估了 EGF 检测到的源是否与程序结果相关。
使用 Ablamap®软件从先前接受过局灶性冲动和转子调制引导消融的 64 极篮状导管记录的单极数据中回顾性生成 EGF 图。我们根据源活动（SAC）和变异性分析患者的结局。无房颤（AF）定义为随访期间无 AF、非典型扑动或房性心动过速复发。
在 64 例持续性或长期持续性房颤患者的 123 个心房中进行了 EGF 图。SAC 与程序结果的相关性在>26%时达到峰值。S 型 EGF 特征（源依赖性 AF）的特征是 SAC>26%的稳定源，而 C 型（源独立性 AF）的特征是 SAC≤26%的源。在 3、6 或 12 个月随访时出现 AF 复发的病例，其最终 SAC 的中位数为 34%；而无 AF 的患者，其最终 SAC 的中位数显著较低，为 21%（p=0.0006）。最终 SAC 和变异性均高于两个阈值的患者复发率为 94%，而 SAC 和变异性低于阈值的主要源患者的复发率仅为 36%（p=0.0001）。消融后 S 型 EGF 特征与 AF 复发率为 88.5%相关，而 C 型 EGF 特征与复发率为 38.1%相关。
EGF 图可用于可视化活跃的 AF 源。SAC>26%的源似乎与高复发率相关，且消融后存在该源与高复发率相关。
