RT annotation
T1 Functional mapping to reveal slow conduction and substrate progression in atrial fibrillation
A1 Silva García, Etel
A1 Lobo-Torres, Iván
A1 Fernández-Armenta, Juan
A1 Penela, Diego
A1 Fernández García, Marcos
A1 Gómez López, Andrea
A1 Soto-Iglesias, David
A1 Fernández Rivero, Rafael
A1 Vázquez García, Rafael
A1 Acosta, Juan
A1 Acosta, Juan
A1 Bisbal, Felipe
A1 Cano Calabria, Lucas
A1 Berruezo, Antonio
A2 Cirugía
A2 Medicina
K1 Atrial fibrillation
K1 Functional mapping
K1 Hidden slow conduction
AB Aims: The aim of our study was to analyse the response to short-coupled atrial extrastimuli to identify areas of hidden slow conduction (HSC) and their relationship with the atrial fibrillation (AF) phenotype. Methods and results: Twenty consecutive patients with paroxysmal AF and persistent AF (10:10) underwent the first pulmonary vein isolation procedure. Triple short-coupled extrastimuli were delivered in sinus rhythm (SR), and the evoked response was analysed: sites exhibiting double or highly fragmented electrograms (EGM) were defined as positive for HSC (HSC+). The delta of the duration of the bipolar EGM was analysed, and bipolar EGM duration maps were built. High-density maps were acquired using a multipolar catheter during AF, SR, and paced rhythm. Spatial co-localization of HSC+ and complex fractionated atrial EGMs (CFAE) during AF was evaluated. Persistent AF showed a higher number and percentage of HSC+ than paroxysmal AF (13.9% vs. 3.3%, P < 0.001). The delta of EGM duration was 53 ± 22ms for HSC+ compared with 13 ± 11 (10)ms in sites with negative HSC (HSC-) (P < 0.001). The number and density of HSC+ were lower than CFAE during AF (19 vs. 56 per map, P < 0.001). The reproducibility and distribution of HSC+ in repeated maps were superior to CFAE (P = 0.19 vs. P < 0.001). Sites with negative and positive responses showed a similar bipolar voltage in the preceding sinus beat (1.65 ± 1.34 and 1.48 ± 1.47mV, P = 0.12). Conclusion: Functional mapping identifies more discrete and reproducible abnormal substrates than mapping during AF. The HSC+ sites in response to triple extrastimuli are more frequent in persistent AF than in paroxysmal AF.
PB Oxford University Press
SN 1532-2092
YR 2023
FD 2023
LK http://hdl.handle.net/10498/32426
UL http://hdl.handle.net/10498/32426
LA eng
DS Repositorio Institucional de la Universidad de Cádiz
RD 10-may-2026