Persistent atrial fibrillation hierarchical activation: From highest DF sites to wave fractionation at the boundaries

Preclinical studies showed a relationship between high dominant frequency areas (HDFA) and wave fractionation, but evidence in patient who atrial fibrillation (AF) persists for long-term periods (persAF) it is not well defined. This study aims to assess the spatio-temporal organization characteristics at HDFAs is persAF and its impact after per standard pulmonary vein isolation (PVI). Eight persAF patients had a non-contact array catheter deployed into the left atrium to collect up to 2048 AF electrograms (AEG) for 15 s. AEGs were band-pass filtered (3–30 Hz) followed by ventricular far-field cancellation. DF between 4–10 Hz and its respective organization index (OI) were calculated (4 s with 50% overlap) to produce 3D DF and OI maps. HDFA defined as the regions within a 0.25 Hz drop from the highest DF were determined and their centre of gravity (CG) calculated. Highest DF sites showed a higher OI at their core when compared to the periphery (0.422±0.101 vs. 0.386±0.126, p=0.02) and increased again organization at sites distant from the HDFAs. Similarly, after PVI, OI remained higher as compared to their periphery (0.372±0.026 vs. 0.332±0.036, p=0.22), but with significant lower values when compared with baseline (p<0.0001). PersAF patients showed higher organization in the HDFAs core when compared with its periphery.