Electrographic flow mapping for atrial fibrillation: theoretical basis and preliminary observations

Ablation strategies remain poorly defined for persistent atrial fibrillation (AF) patients with recurrence despite intact pulmonary vein isolation (PVI). As the ability to perform durable PVI improves, the need for advanced mapping to identify extra-PV sources of AF becomes increasingly evident. Multiple mapping technologies attempt to localize these self-sustained triggers and/or drivers responsible for initiating and/or maintaining AF; however, current approaches suffer from technical limitations. Electrographic flow (EGF) mapping is a novel mapping method based on well-established principles of optical flow and fluid dynamics. It enables the full spatiotemporal reconstruction of organized wavefront propagation within the otherwise chaotic and disorganized electrical conduction of AF. Given the novelty of EGF mapping and relative unfamiliarity of most clinical electrophysiologists with the mathematical principles powering the EGF algorithm, this paper provides an in-depth explanation of the technical/mathematical foundations of EGF mapping and demonstrates clinical applications of EGF mapping data and analyses.

Automated summary

Ablation strategies are still unclear for persistent atrial fibrillation patients who experience recurrence despite intact pulmonary vein isolation. Advanced mapping techniques that can identify extra-pulmonary vein sources of atrial fibrillation are increasingly necessary as the ability to perform durable pulmonary vein isolation improves. Electrographic flow mapping provides a novel method for mapping atrial fibrillation by reconstructing organized wavefront propagation within chaotic electrical conduction. This paper explains the technical and mathematical foundations of electrographic flow mapping and demonstrates its clinical applications.