Spatial and Temporal Variability of Rotational, Focal and Irregular
Activity: Practical Implications for Mapping of Atrial Fibrillation
Abstract
Background Charge density mapping of atrial fibrillation (AF) reveals
dynamic patterns of localised rotational activation (LRA), irregular
activation (LIA) and focal firing (FF). Their spatial stability,
conduction characteristics and the optimal duration of mapping required
to reveal these phenomena and has not been explored. Methods Bi-atrial
mapping of AF propagation was undertaken and variability of activation
patterns quantified up to a duration of 30-seconds(s). The frequency of
each pattern was quantified at each vertex of the chamber over 2
separate 30s recordings prior to ablation and R2 calculated to quantify
spatial stability. Regions with the highest frequency were identified at
increasing time durations and compared to the result over 30s using
Cohen’s kappa. Properties of regions with the most stable patterns were
assessed during sinus rhythm and extrastimulus pacing. Results In
twenty-one patients, 62 paired LA and RA maps were obtained. LIA was
highly spatially stable with R2 between maps of 0.83(0.71-0.88) compared
to 0.39(0.24-0.57) and 0.64(0.54-0.73) for LRA and FF, respectively. LIA
was also most temporally stable with a kappa of >0.8
reached by 12s. LRA showed greatest variability with
kappa>0.8 only after 22s. Regions of LIA were of normal
voltage amplitude (1.09mv) but showed increased conduction heterogeneity
during extrastimulus pacing (p=0.0480). Conclusion Irregular activation
patterns characterised by changing wavefront direction are temporally
and spatially stable in contrast with rotational patterns that are
transient with least spatial stability. Focal activation appears of
intermediate stability. Regions of LIA show increased heterogeneity
following extrastimulus pacing and may represent fixed anatomical
substrate.