INTRODUCTION
Pulmonary vein isolation (PVI) has been the cornerstone of atrial
fibrillation (AF) ablation. However, the single procedure success rates
are limited, particularly in persistent and longstanding persistent
AF.1 However, additional strategies including linear
ablation and ablation of complex fractionated atrial electrograms
(CFAEs) 2,3 have not indicated any efficacy benefit
over a PVI alone in non-paroxysmal AF patients. 4
A strategy based on low-voltage areas (LVAs) as detected by left atrial
(LA) voltage mapping during sinus rhythm (SR) has recently been reported
because LVAs are a predictor of AF recurrence after AF ablation.5,6,7 Furthermore, the recent utility of the Advisor
HD grid HD (HDG) mapping catheter (Abbott Technologies, St Paul,
Minnesota, USA) might lead to new and unique mapping techniques. The HDG
contributes to the bipolar recording of activation parallel and
perpendicular to the splines, which differs from conventional
mapping.8 Therefore, the HDG can create high density
maps to define anatomical substrates regardless of the direction of the
activation.
High-DF sites may be potential selective targets for localized sources
maintaining AF in non-paroxysmal AF patients.9,10,11However, high-DF areas change spatiotemporally and the DF based ablation
is still controversial.12 Therefore, we previously
reported the importance of high-DF sites overlapping with present LVAs
using a conventional mapping catheter after the PVI.13 Recently, the areas in which rotational activations
are frequently observed are automatically detected by a novel phase
mapping system among some ablation strategies targeting AF drivers.14-16 This study aimed to evaluate the relationship
between the DFs/rotors and LVAs detected using the HDG after PVI in
non-paroxysmal AF.