Two Independent Mapping Techniques Identify Rotational Activity Patterns at Sites of Local Termination During Persistent Atrial Fibrillation

The mechanisms for atrial fibrillation (AF) are unclear in part because diverse mapping techniques yield diverse maps ranging from stable organized sources to highly disordered waves. We hypothesized that AF mechanisms may be clarified if mapping techniques were compared in the same patients, and referenced to a clinical endpoint. We compared 2 independent AF mapping techniques in patients in whom local ablation terminated persistent AF before pulmonary vein isolation (PVI). Techniques and Results We identified 12 patients with persistent AF (61.2±10.8 years, 4 female) in whom mapping with 64 pole baskets and technique 1 (activation/phase mapping, FIRM) identified rotational activation patterns during at least 50% of the 4-second mapping interval and targeted ablation at these rotational sites terminated AF to sinus rhythm (n = 10) or atrial tachycardia. We analyzed the unipolar electrograms of these patients to determine phase maps of activation by an independent technique 2 (Kuklik, Schotten et al., IEEE Trans Biomed Eng 2015). Compared to technique 1, technique 2 revealed a source in 12/12 (100%) cases with spatial concordance in all cases (p