Temporally Stable Frequency Mapping and Ultra High-Density Voltage Map in Persistent Atrial Fibrillation Ablation

Objectives: The goal of this study was to retrospectively analyze the long-term outcome after persistent atrial fibrillation (AF) ablation by combining continuous wavelet transform (CWT) and left atrial (LA) voltage mapping. Background: CWT analysis is a frequency analysis to search the area of stable high frequency (stable pseudo frequency [sPF]) during AF. Methods: CWT analysis were performed in persistent AF (109 patients, 65{plus minus}10 years) pre-PVI in PVs, and 8 sites in LA to investigate highest sPF site. Patients were divided into PV dominant group (highest sPF in PV) or LA dominant group (highest sPF in LA). The average frequency of LA was compared between pre-PVI and post-PVI. Patients were also classified into three low voltage area (LVA) groups according to sinus voltage map after PVI; Healthy group (no LVA {less than or equal to}1.0mV), Mild LVA group (no LVA {less than or equal to}0.5mV, but with >0.5mv and {less than or equal to}1.0mV), and Dense LVA group (presence of LVA {less than or equal to}0.5mV). Results: Highest sPF was found in PVs in 70 patients and in LA in 38 patients. One patient did not have sPF (classified as undetermined). A significant decrease of whole LA average frequency post-PVI was recognized in PV dominant group, but not in LA dominant group. After 2-year follow-up, AF-free survival was better in PV dominant group (P<0.002). This trend was seen throughout all LVA groups. Location of highest sPF was the strongest predictor of AF recurrence (P = 0.026). Conclusion: Location of highest sPF had a significant impact on the result of ablation in persistent AF.