Drifting rotor prevalence is associated with dominant frequency reduction after persistent atrial fibrillation ablation

Identification and targeting of arrhythmogenic atrial regions remains an evident challenge in persistent atrial fibrillation patients. Frequency and phase analysis have shown their usefulness for better understanding the arrhythmia. This study aimed to investigate the spatio-temporal association between dominant frequency (DF) and re-entrant phase activation areas. For this, eight persistent AF patients were enrolled and 2048 left atrial AF electrograms (AEG) were acquired from each for up to 15 seconds following ventricular far-field cancellation. DF and phase singularity (PS) points were automatically identified and tracked over consecutive frames for spatio-temporal analysis. As result, simultaneous not spatio-temporally stable PS points were identified drifting throughout the left atrium. After pulmonary vein isolation PS incidence reduced (90.8±59.8 vs. 23.8±31.6, p<0.05), concomitantly, DF decreased (DFmax from 7.3±0.4 Hz to 7.1±0.8 Hz, p=0.26 and DFmin from 5.1±1.2 Hz to 4.2±1.1 Hz, p<0.05). Higher concentrations of PS areas seem to have a certain degree of co-localisation with HDF regions. Both frequency and phase analyses seem to have a role in identifying atrial regions that might be perpetuating persistent AF. Concatenated DF/PS mapping may contribute as an auxiliary tool for AF ablation.