Current AF Classifications do not reflect pathophysiology
Understanding the pathophysiology of AF is critical for effective treatment
AF pathophysiology is complex resulting in heterogenous clinical disease
One-size-fits-all and anatomic approaches have failed due to disease heterogeneity
Key to improving AF ablation outcomes is to treat the underlying AF disease pathophysiology
While pulmonary vein isolation (PVI) appears sufficient to treat some patients with persistent AF, a pressing need exists for technologies that can identify AF sources in patients who present for redo procedures with all pulmonary veins already isolated—an increasingly encountered clinical situation.
Electrographic Flow™ (EGF) mapping with the OptiMap™ System enables the full spatiotemporal reconstruction of atrial electrical wavefront propagation to identify active AF sources1 and estimates the consistency of observed wavefront patterns. Details of the pre-processing steps and algorithms have been published.2
EGF sources appear clinically relevant and their presence post-ablation correlates with high rates of AF recurrence.3,4
EGF mapping can detect these extra-PV sources of AF by organizing the chaotic endocardial electrograms to show the time-dependent activity of these drivers/triggers in the right and left atria, representing anatomically feasible targets for ablation.5
In a prospective, single-center study of 70 consecutive patients with persistent AF, EGF-guided ablation offers a more targeted and patient-specific ablation strategy beyond PVI: PVI + EGF-guided ablation resulted in lower AF recurrence rates (25.6%) compared with PVI-only (62.5%) or PVI + LINES (53.3%)[p=0.02].6
In the FLOW-AF randomized controlled trial of 85 patients with persistent or long-standing persistent AF, ablating EGF sources improved one-year freedom from AF by 51% on an absolute basis.7
First and only 510(k) cleared AF mapping system with randomized controlled trial results demonstrating a statistically significant improvement in freedom from AF at 12 months post-ablation among patients treated with PVI + EGF-guided ablation v. PVI-only.7
EGF algorithms to detect the presence of functional mechanisms of AF enable stratification into distinct EGF phenotypes that may be useful in predicting procedural outcomes, and perhaps in predicting ablation strategy.7
As shown in the FLOW-AF study, EGF mapping is safe and effective for the evaluation and treatment of patients with non-paroxysmal AF.7
Current studies are limited by small number of non-randomized patients and technical limitations related to the use of the FIRMap basket mapping catheter. Larger studies are warranted to assess the results in a greater number of patients and assess if EGF-based ablation improves freedom fromAF/AT/AFL.
The OptiMap™ System can be used with any commercially available 3-dimensional electroanatomic mapping/navigation system and can be used with any commercially available ablation catheters following their approved indications for use.
OptiMap™ System
The OptiMap™ System is used to analyze electrogram (EGM) signals and display results in a visual format for evaluation by a physician in order to assist in the diagnosis of complex cardiac arrhythmias.
The OptiMap™ Catheter
For use in cardiac electrophysiology procedures to assist in the diagnosis of arrhythmias that may be difficult to identify using conventional mapping systems alone (i.e., linear mapping catheters). The OptiMap™ Catheter may also be used for delivery of externally generated pacing stimuli.
