Two Independent Mapping Techniques Identify Rotational Activity Patterns at Sites of Local Termination During Persistent Atrial Fibrillation
Some recent mapping studies2 propose that rotational or focal drivers in localized regions maintain AF, with promising results by ablating such sites at independent centers.4 This concurs with optical mapping of AF in human atria.9 However, other studies disagree. First, AF mapping historically shows disorganized waves with no10 or very few11 drivers, typically in patients with permanent AF at nonarrhythmia surgery. Second, some studies show organized drivers on dominant frequency analysis12 that may be unstable by activation13 or phase14 mapping. Third, AF‐driver ablation outcomes are disappointing at some centers.17 It is unresolved if conflicting results reflect patient selection, methodology or intercenter variations in the results of any approach to AF ablation.20
We hypothesized that AF mechanisms may be clarified if independent mapping techniques were compared in the same patients, referenced to the endpoint of AF termination. We report on an early cohort of patients at our institution in whom limited ablation guided by one mapping technique (Focal Impulse and Rotor Mapping, FIRM) terminated persistent AF prior to pulmonary vein (PV) isolation, and compared the results with a distinct second mapping technique applied to the same clinical data.