Journal of cardiovascular electrophysiology · 2026
Substrate Unmasking via High-Density Omnipolar Mapping Under Rapid Pacing in Atrial Fibrillation.
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Wang Xinmeng, Chan Juan, Jia Ruikun, Sun Xiaochi, Bai Lu, Wang Luzhao, Wen Yi, Li Jiong, Cui Kaijun
Аннотация
BACKGROUND: Substrate mapping for atrial fibrillation (AF) ablation commonly relies on sinus rhythm (SR) maps, which may overlook rate-dependent electrophysiological changes.
OBJECTIVE: This study aimed to evaluate the diagnostic and prognostic value of rate-dependent substrate characterization using high-density omnipolar mapping under rapid pacing.
METHODS: In a prospective cohort of 46 patients (5 controls, 22 paroxysmal AF [PAF], 19 persistent AF [PeAF]), bi-atrial conduction velocity (CV) and low-voltage zones (LVZ) were assessed across seven mapping conditions: SR and graded pacing (600, 400, 300 ms) from the distal coronary sinus (CSD) and high right atrium (HRA).
RESULTS: CV decreased with faster pacing across all cohorts. At 300 ms, PeAF patients exhibited significantly slower CV than PAF and controls (0.60 ± 0.07 vs. 0.72 ± 0.06 vs. 0.90 ± 0.05 m/s; p < 0.001). The global LVZ burden was greater in PeAF than PAF at 300 ms (58.71 [39.84-68.69] vs. 26.18 [20.94-37.40]; p = 0.009). Decremental pacing was associated with progressive bi-atrial conduction slowing in AF, most pronounced in PeAF (0.76 ± 0.08 vs. 0.74 ± 0.06 vs. 0.69 ± 0.02 vs. 0.60 ± 0.07 m/s; p < 0.001). Rapid pacing at 300 ms showed the numerically highest discriminative capacity. Patients with global CV < 0.67 m/s (AUC 0.749; p = 0.019) or LVZ% > 43.4% (AUC 0.681; p = 0.008) at 300 ms were associated with a higher risk of recurrence.
CONCLUSION: Rapid pacing at 300 ms reveals latent bi-atrial substrate occult during SR and may improve risk stratification.
OBJECTIVE: This study aimed to evaluate the diagnostic and prognostic value of rate-dependent substrate characterization using high-density omnipolar mapping under rapid pacing.
METHODS: In a prospective cohort of 46 patients (5 controls, 22 paroxysmal AF [PAF], 19 persistent AF [PeAF]), bi-atrial conduction velocity (CV) and low-voltage zones (LVZ) were assessed across seven mapping conditions: SR and graded pacing (600, 400, 300 ms) from the distal coronary sinus (CSD) and high right atrium (HRA).
RESULTS: CV decreased with faster pacing across all cohorts. At 300 ms, PeAF patients exhibited significantly slower CV than PAF and controls (0.60 ± 0.07 vs. 0.72 ± 0.06 vs. 0.90 ± 0.05 m/s; p < 0.001). The global LVZ burden was greater in PeAF than PAF at 300 ms (58.71 [39.84-68.69] vs. 26.18 [20.94-37.40]; p = 0.009). Decremental pacing was associated with progressive bi-atrial conduction slowing in AF, most pronounced in PeAF (0.76 ± 0.08 vs. 0.74 ± 0.06 vs. 0.69 ± 0.02 vs. 0.60 ± 0.07 m/s; p < 0.001). Rapid pacing at 300 ms showed the numerically highest discriminative capacity. Patients with global CV < 0.67 m/s (AUC 0.749; p = 0.019) or LVZ% > 43.4% (AUC 0.681; p = 0.008) at 300 ms were associated with a higher risk of recurrence.
CONCLUSION: Rapid pacing at 300 ms reveals latent bi-atrial substrate occult during SR and may improve risk stratification.