Close Association Between Subjective Assessment of Spatiotemporal Dispersion Electrograms and Objective Fractionation Map

Although catheter ablation strategies for persistent atrial fibrillation (AF) have not been determined yet,¹ a strategy targeting spatiotemporal dispersion electrograms (STDE) sheds light on reducing AF recurrence.² Because assessing STDE is subjective, objective methods to identify it are warranted to standardize this strategy. We report a 65-year-old woman with persistent AF whose fractionation map visualized by an electroanatomical mapping system (EnSite Precision Cardiac Mapping System with HD grid, Abbott, Abbott Park, IL, USA) well matched the area of subjectively assessed STDE (Figure, Supplementary Movie). The procedure was conducted according to the Declaration of Helsinki. Subjectively assessed STDE was defined as clusters of electrograms that displayed interelectrode time and space dispersion at a minimum of 3 adjacent bipolar electrodes such that activation spread over all the cycle length of AF.² Yellow tags indicated subjective STDE that were consistently distributed in the abnormal area colored by a fractionation map (width of 5 ms, refractory of 6 ms, segment length of 1.0, and a color threshold between 25 and 35). Based on the STDE distribution, left atrial posterior wall isolation was performed in addition to pulmonary vein isolation. Performing post-hoc analysis of 1,892 mapping points, the receiver operating characteristic curve demonstrated that fractionation >24 identified STDE with a specificity of 0.85, sensitivity of 0.88, positive predictive value of 0.40, and negative predictive value of 0.98 (area under the curve of 0.92). Therefore, an objective fractionation map could be an alternative to the subjective STDE and be helpful in standardizing STDE ablation.

Figure.

Colored fractionation map and manually tagged spatiotemporal dispersion electrograms.

Disclosures

There are no conflicts of interest.

Supplementary Files

Supplementary Movie. Fractionation map.

Please find supplementary file(s);

https://doi.org/10.1253/circj.CJ-22-0488

References

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