Simple and accurate catheter mapping technique to predict atrial fibrillation foci in the pulmonary veins or posterior right atrium.

Objectives: The purpose of this study was to investigate the efficacy of a novel catheter mapping technique for predicting atrial fibrillation (AF) foci.

Background: Most AF originates from pulmonary veins (PVs), but some originate from the right atrium.

Methods: We developed an algorithm by correlating the cardiac recordings obtained from multielectrode catheters placed in the posterior right atrium (RA) and esophagus during pacing from the PVs and superior vena cava (SVC) or crista terminalis (CT) in 10 AF patients. We tested the algorithm's accuracy prospectively in 46 AF patients.

Results: During pacing from the left PVs, the esophageal potentials preceded all other potentials. During pacing from both the right PVs and SVC-CT, the first component (FP) of the double potential (DP) recorded in the posterior RA preceded all other potentials. The amplitude of the FP was higher than that of the second DP component during pacing from the SVC-CT, whereas the reverse occurred from the right PVs. The activation sequence of the FPs and esophageal potentials was from superior to inferior during pacing from the superior PVs, whereas the reverse occurred from the inferior PVs. The accuracy of predicting 34 foci in the right PVs, 28 foci in left PVs, and 6 foci in SVC-CT was 100% for all, respectively. The accuracy of discriminating foci in the superior PVs from those in the inferior PVs was 97% in the right PVs and 96% in the left PVs.

Conclusions: The technique using mapping catheters placed in the posterior RA and esophagus is feasible and effective for mapping and ablating AF.