Nilsson Kent R, Anerao Amitesh, Kong Melissa H, Derejko Pawel, Szili-Török Tamás, Goyal Sandeep, Turagam Mohit, Verma Atul, Castellano Steven
Department of Cardiac Electrophysiology, Piedmont Heart Institute, Athens, GA 30309, USA.
Medical College of Georgia, Augusta University/University of Georgia Partnership, Athens, GA 30602, USA.
J Clin Med. 2025 Jan 22;14(3):693. doi: 10.3390/jcm14030693.
Electrographic flow (EGF) mapping allows for the visualization and quantification of atrial fibrillation (AF) wavefront propagation patterns. EGF-identified sources were shown in the randomized controlled trial to significantly increase the likelihood of AF recurrence within 1 year if left unablated. Electrographic flow consistency (EGFC) additionally measures the stability of observed wavefront patterns, such that patients with more organization have a healthier substrate and lower recurrence. Source presence and EGFC can be used collectively to assign mechanistic phenotypes to AF patients. The patient phenotypes, treatment modalities, and outcomes in were compared with those of patients in the ensuing , which was conducted by separate physicians at discrete clinical centers. Patients with low EGFC (≤0.62) had a 12-month freedom from AF (FFAF) of 46%, while those with a high mean EGFC (>0.62) had a FFAF of 81%. Right atrial EGFC was correlated with left atrial EGFC, and the highest recurrence occurred in those with biatrial low EGFC. Source presence also affected the recurrence rates in both trials, such that the presence of EGF-identified sources in PVI-only patients lowered the FFAF from 65% to 36%, but the elimination of sources produced a 30% absolute increase in FFAF from 36% to 66%. Patient outcomes by EGF-based AF phenotype were consistent across two cohorts of patients from separate clinical trials at distinct centers. Patients with a high EGFC and no sources post-procedure had the best outcomes. EGF mapping provides insights into underlying disease pathophysiology and may be employed prospectively to predict recurrence.
电图血流（EGF）标测可实现心房颤动（AF）波前传播模式的可视化和量化。在随机对照试验中显示，如果不进行消融，EGF识别出的起源灶会显著增加1年内AF复发的可能性。电图血流一致性（EGFC）还可测量观察到的波前模式的稳定性，因此组织性更高的患者具有更健康的基质和更低的复发率。起源灶的存在和EGFC可共同用于为AF患者确定机制表型。将[前文提及的研究中的]患者表型、治疗方式和结局与随后[另一研究中的]患者进行比较，后者由不同临床中心的不同医生进行。EGFC较低（≤0.62）的患者12个月无AF（FFAF）率为46%，而平均EGFC较高（>0.62）的患者FFAF率为81%。右心房EGFC与左心房EGFC相关，双心房EGFC较低的患者复发率最高。起源灶的存在在两项试验中也影响复发率，仅行肺静脉隔离（PVI）的患者中存在EGF识别出的起源灶会使FFAF从65%降至36%，但消除起源灶会使FFAF从36%绝对增加30%至66%。基于EGF的AF表型的患者结局在来自不同中心的两项独立临床试验的两组患者中是一致的。术后EGFC高且无起源灶的患者结局最佳。EGF标测可深入了解潜在疾病的病理生理学，并且可前瞻性地用于预测复发。
