Sites of Focal Atrial Activity Characterized by Endocardial Mapping During Atrial Fibrillation

ObjectivesThe aim of the present study was to assess the feasibility of identifying sites of focal atrial activity by localized high-density endocardial mapping during atrial fibrillation (AF).BackgroundSites of focal activity in the left atrium have been demonstrated by epicardial mapping during AF.MethodsTwenty-four patients (15 with paroxysmal, 3 with persistent, and 6 with permanent AF) underwent endocardial mapping during AF. A 20-pole catheter with five radiating spines was used to map both atria for 30 s in each of 10 pre-determined segments. A focal activity was defined as ≥3 atrial cycles with activation spreading from center to periphery of the mapping catheter. Catheter ablation was performed independent of the mapping results.ResultsSpontaneous focal activities were observed in 13 sites in the left atrium (9%; anterior 1, roof 2, posterior 6, inferior 4) in 12 patients (9 paroxysmal, 3 persistent). Focal activity was observed continuously (two sites) or intermittently (11 sites, median 5 episodes), and associated with shortening of the cycle length (from 183 ± 33 ms to 172 ± 29 ms; p < 0.05). The mean duration of an intermittent episode was 1.5 s (range 0.4 to 7.1 s). Atrial fibrillation terminated without ablation at the foci in all of 12 patients, but in 2 of them, re-initiated arrhythmia was successfully ablated at these foci. Nine of these 12 patients (75%) were arrhythmia-free without antiarrhythmic drugs during a follow-up period of 7.0 ± 3.1 months.ConclusionsTermination of AF without ablation at the sites of atrial focal activity suggests that this activity may be triggered by impulses originating from other regions, such as the pulmonary veins.