Identification of the Crucial Substrates of Persistent Atrial Fibrillation by Isochronal Spectrum Analysis

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Introduction: High frequency activation (HFA) were considered to be the critical substrate for AF maintaining. The purpose of this study was to detect the crucial substrates of persistent atrial fibrillation (PeAF) using a noncontact mapping system. Methods: 24 patients (male 24, age 53.1±11.2 years) with PeAF (duration 18±9 m) referred for ablation using a noncontact mapping (Ensite) were enrolled. LA activity during AF ongoing prior to ablation were recorded. ~8 sec activation data at 2048 locations were detected and processed into a Custom-written Matlab system for frequency analysis. Local atrial frequencies were estimated and superposed onto the individual 3D LA geometry. Regions with HFA were identified. Results: LA enlarge were documented in 14 patients (LA diameter: 40.7±4.4 mm). LA frequencies in PeAF varied from 4.0 to 11.8 Hz. Multiple regions with HFA were seen in 22 of 24 patients, a total of 77 regions were detected (mean 3.2/pts) as HFA areas. Of all 24 patients, HFA occurred most commonly in roof (21/24), interatrial septum (15/24), ridge (14/24) and anterior wall (10/24). HFA was much less common adjacent to the PVs (4/24). Conclusions: Crucial substrates of PeAF were identified in this study, mostly located in roof, ridge, septum, and anterior wall. Ablation lines across these regions may help to terminate the arrhythmia.