Introduction:
It is currently not possible to non-invasively identify patients with atrial fibrillation (AF) who may respond acutely to ablation. We hypothesized that high resolution body surface mapping can identify specific distributions of AF in individuals that predict acute success from ablation.
Objective:
To correlate 64 lead body surface ECG in AF to acute ablation response and non-invasively identify patients in whom ablation does and does not terminate AF.
Method:
Fig A shows 64 body surface electrodes in N=17 consecutive AF patients (14 persistent AF, 67 ± 9.06 years). Spectral dominant frequency (DF) from 4096-point FFT, cycle length, AF electrogram amplitude were measured in 200-300 time slices of duration 60s between patches on the body surface representing each atrium (Fig A).
Results:
Ablation terminated AF in N=7/17 patients (41.2%, Fig. B). Patients with AF termination had more organized AF than those without termination, indicated by lower DF on body surface mapping of the regions corresponding to left (5.00 ± 1.33 vs 5.47 ± 1.30, p < 0.001) and right atrium (5.16 ± 1.50 vs 5.50 ± 1.01, p < 0.003) (Fig C shows composite). DF was stable without statistically significant variations across 20s slices spanning the full minute, supporting interpretability of mechanisms from this analysis (p = NS). Further, AF signal amplitude averaged across left and right atria was lower in patients with AF termination (65.47 ± 36.9 vs 120.13 ± 99.9, p < 0.001) (Fig D).
Conclusion:
Body surface analysis of AF can non-invasively identify patients in whom ablation may acutely terminate AF. Future studies should determine if this approach can predict who may ultimately achieve long term freedom from AF, and whether body surface signatures are representative enough to be analyzed days prior to the procedure.
The body surface mapping in patients with non obstructive hypertrophic cardiomyopathy.