Transcript Slide 1

Montawatt Amnueypol, MD; Oraporn See, MD, FACC, FASE; Sukit Yamwong, MD; Tachapong Ngarmukos, MD, FACC; Sirin Apiyasawat, MD, FACC; Pakorn Chandanamattha, MD;
Tarinee Tangcharoen, MD; Charaslak Charoenpanichkit , MD.
Cardiovascular Unit, Department of Medicine, Ramathibodi hospital.
Electro – Anatomical Mapping
Triggers
*PV, SVC, Ligament of Marshall, CS, Crista
terminalis
Perpetuates (Substrates)
Conduction↓, ERP↓, AP duration ↓, AP plateau
Complex Fractionated Atrial Electrograms
(CFAE)
Mechanism of Atrial Fibrillation.
Purpose
This study aim to validate relationship between CFAM identified
by mechano – anatomical mapping and CFAE by electro –
anatomical mapping.
Population
• Five AF patients were enrolled from Jan to Dec 2008.
• Mean age 48±10.67 yrs and AF duration 6 (3 – 13) yrs
Mechanogram by Tissue Doppler Imaging had shown
significantly correlated with electrogram in AF patients.
Complex Fractionated Atrial
Mechanogram (CFAM)
Electro – Anatomical Mapping was used to locate CFAE foci for ablation
in 3D cardiac anatomy.
Method
Paroxysmal/Persistent AF were enrolled (16)
Spontaneous AF rhythm during both mapping (5)
Results
3D and TDI Echocardiography
Total 45 sites from LA and RA were analyzed. Our study showed
significant high agreement between both CFAE and CFAM maps,
with Kappa 0.758 (p – value <0.001). Sensitivity 94%, Specificity
92%, PPV 97%, NPV 86%, Positive LR 11.75, Negative LR 0.07
Catheter ablation substrate for AF
Conclusion
Complex fractionated electrograms (CFAEs) in patients with
spontaneous AF can be identified with precision non-invasively,
using combination of TDI and 3D echocardiography.
Mechano – Anatomical mapping
CFAM were scored by two
Echocardiographers.
Electro – Anatomical mapping
CFAE were scored by
two Electrophysiologists
Compare CFAM vs CFAE scores (0 – 2) in each sites (9 sites/case)
by Kappa agreement
Mechano – Anatomical
Mapping