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Automated detection of repetitive focal activations in persistent atrial fibrillation: Validation of a novel detection algorithm and application through panoramic and sequential mapping

Honarbakhsh, S; Schilling, RJ; Providencia, R; Keating, E; Sporton, S; Lowe, M; Lambiase, PD; ... Hunter, RJ; + view all (2019) Automated detection of repetitive focal activations in persistent atrial fibrillation: Validation of a novel detection algorithm and application through panoramic and sequential mapping. Journal of Cardiovascular Electrophysiology , 30 (1) pp. 58-66. 10.1111/jce.13752. Green open access

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Abstract

INTRODUCTION: Identifying drivers in persistent atrial fibrillation (AF) remains challenging. We sought to validate an automated system for detection of focal activation using basket and PentaRay catheters in AF. METHODS: Patients having ablation for atrial tachycardia (AT) and persistent AF were mapped. Thirty-second unipolar basket and PentaRay recordings were analyzed using CARTOFINDER. Focal activation or "region of interest" (ROI) was defined as more than or equal to 2 consecutive focal activations with one electrode leading relative to its neighbors with QS morphology on the unipolar electrogram. ROI was validated in AT. AF patients were mapped to (1) look for evidence of focal activations on wavefront maps, (2) evaluate whether these were detected as ROI on basket recordings, and (3) whether these sites could be identified on sequential PentaRay recordings. RESULTS: ROIs were identified in five focal ATs but none of 16 reentrant ATs. Twenty-eight AF patients had 35 focal drivers identified from basket wavefront maps with an ablation response in all (16 cycle length slowing and 19 AF termination). Thirty focal activations were detected on basket ROI maps (86%). Twenty-three of 28 patients had sequential PentaRay mapping and 22 of 30 focal drivers in these patients (73%) were identified as ROI. These drivers had greater temporal stability (3.6 ± 0.6 vs 2.7 ± 0.6; P < 0.001), higher recurrence rate (12.4 ± 2.7 vs 7.2 ± 0.9; P < 0.001), and more frequently were associated with AF termination ( P < 0.001) compared with those not identified as ROI. CONCLUSIONS: Focal activations can be detected in AF using sequential recordings. The ablation response at focal sources suggests they may be viable therapeutic targets.

Type: Article
Title: Automated detection of repetitive focal activations in persistent atrial fibrillation: Validation of a novel detection algorithm and application through panoramic and sequential mapping
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/jce.13752
Publisher version: https://doi.org/10.1111/jce.13752
Language: English
Additional information: © 2018 The Authors. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/).
Keywords: atrial fibrillation, atrial tachycardia, CARTOFINDER mapping, catheter ablation, focal drivers, rotors
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10059627
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