Novel Mapping Technique for Localization of Focal and Reentrant Activation During Atrial Fibrillation

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Pulmonary vein (PV) isolation is performed for both paroxysmal and persistent atrial fibrillation (AF), but its efficacy is relatively limited in the latter. In the last decade, ablation techniques adjunctive to PV isolation were developed to improve clinical outcome of AF ablation. Disappointingly, recent clinical trials have failed to demonstrate the superiority of adjunctive ablation techniques over PV isolation alone in persistent AF.1 Thus, development of new ablation techniques is required for persistent AF.
Prior mapping studies demonstrated 2 types of activation during AF, focal and reentrant, both of which play a driving role in the maintenance of AF.3 Catheter ablation targeting such drivers should therefore improve clinical outcome.8 However, locating and identifying these drivers during ablation procedures remains challenging. Additionally, the impact of ablation at the sites of these drivers on clinical outcomes is unclear. We sought to apply a new mapping technology, Ripple Map, for analysis of electrograms from a high‐density mapping catheter to distinguish focal and reentrant activation during AF.
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