209-05: Does flecainide pre-treatment helps to identify the most important players?

Sana Amraoui, Carole Pomier, Frederic Sacher, Nicolas Derval, Arnaud Denis, Grégoire Massoullié, Ghassen Cheniti, Philippe Ritter, Pierre Bordachar, Mélèze Hocini, Michel Haïssaguerre, Pierre Jaïs
2016 Europace  
The identification of AF sources maintaining AF is possible using ECGM (ECG mapping). We sought to study if the rotors persisting after Flecainide (Fleca) infusion could be associated to AF termination during ablation. Methods: ECGM was used to prospectively acquire AF maps before and after Fleca infusion, the day before persistent AF ablation. Phase mapping of AF were obtained with biatrial geometry and relative electrode positions from a CT scan and an array of 252 body surface electrodes.
more » ... g ventricular pauses were mapped 10 min after Fleca infusion. The AF drivers were targeted during ablation, blinded of the results of the Fleca map. Results: 13 pts (60 + 10, 11 m) with persistent AF (9 + 4mo) had a dramatic reduction of rotors from 81 + 38 rotors in 7 + 1 regions to 56 + 52 in 4 + 2 regions after Fleca infusion ( p ¼ 0.01 and ,10-3respectively). AF termination was obtained in 11/13 pts (85%) after 25 + 13 min of RF. Termination site was in a region where rotors persisted after Fleca in 9/11 pts (82%). The 2 pts without AF termination had no reduction in rotor's number after Fleca: 44 unchanged in 1, and 104 to 126 in the other. Conclusion: The rotors persisting after Fleca infusion are predominant sites of AF termination. They seem to play a major role in AF and targeting these rotors first could reduce procedure time and RF delivery. This test may also screen good candidates to catheter ablation.
doi:10.1093/europace/18.suppl_1.i141 fatcat:esdnqlvzjnfzdhpstf6qb6v6te