Electrographic flow mapping of persistent atrial fibrillation: Intra-and inter-procedure reproducibility in the absence of 'ground truth'

Vivek Y. Reddy, Melissa H. Kong, Jan Petru, Abhishek Maan, Moritoshi Funasako, Kentaro Minami, Peter Ruppersberg, Srinivas Dukkipati, Petr Neuzil

Research output: Contribution to journalArticlepeer-review


Aims: Validating mapping systems that identify atrial fibrillation (AF) sources (focal/rotational activity) is confounded by the absence of ground truth. A key concern of prior mapping technologies is spatiotemporal instability, manifesting as poor map reproducibility. Electrographic flow (EGF) employs a novel algorithm that visualizes atrial electrical wavefront propagation to identify putative AF sources. We analysed both intra-(3min) and inter-(>3 months) procedure EGF map reproducibility. Methods and results: In 23 persistent AF patients, after pulmonary vein isolation (PVI), EGF maps were generated from 3 serial 1min recordings using a 64-electrode basket mapping catheter (triplets) at right and left atrial locations. Source prevalence from map triplets was compared between recordings. Per protocol, 12 patients returned for 3-month remapping (1 non-inducible): index procedure post-PVI EGF maps were compared with initial EGF remapping at 3-month redo. Intra-procedure reproducibility: Analysing 224 map triplets (111 right atrium, 113 left atrium) revealed a high degree of map consistency with minimal min-To-min shifts: 97 triplets (43%), exact match of leading sources on all 3 maps; 95 triplets (42%), leading source within 1 electrode space on 2 of 3 maps; and 32 triplets (14%), chaotic leading source pattern. Average deviation in source prevalence over 60s was low (6.4%). Inter-procedure reproducibility: spatiotemporal stability of EGF mapping >3 months was seen in 16 of 18 (89%) sources mapped in 12 patients with (re)inducible AF. Conclusion: Electrographic flow mapping generates reproducible intra-and inter-procedural maps, providing rationale for randomized clinical trials targeting these putative AF sources.

Original languageEnglish
Article numbereuad308
Issue number11
StatePublished - 1 Nov 2023


  • Basket catheter
  • Electrographic flow mapping
  • Panoramic mapping
  • Persistent atrial fibrillation


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