"CHA2DS2-VASC Score is Related to Electrographic Flow Mapping Phenotype" by Ilana B. Kutinsky, Kent R. Nilsson et al.
 

CHA2DS2-VASC Score is Related to Electrographic Flow Mapping Phenotype

Document Type

Conference Proceeding

Publication Date

4-2025

Publication Title

Heart Rhythm

Abstract

Background: Electrographic Flow (EGF) mapping is a technique that generates near real-time visualizations of atrial electrical wavefront propagation. Two factors have been used for phenotyping and found to be independently associated with higher rates of atrial fibrillation (AF) recurrence: presence of extra-pulmonary vein (PV) sources and low Electrographic Flow Consistency (EG Flow) representing chaotic flow and abnormal substrate. Women were previously found to have more sources but higher EG Flow (healthier substrate). Objective: Determine the relationship of CHA2DS2-VASc score with source presence and EG Flow categorization using EGF mapping. Methods: Unipolar electrograms were prospectively recorded from 113 patients to generate EGF maps. Sources were identified and EG Flow was categorized from post-PV isolation (PVI) maps taken in 5 standardized, biatrial basket positions. Outcomes were determined after 12 months. Results: There were 102 persistent and 9 paroxysmal patients pooled with mean age 66±10 yrs, 31% female sex, and mean left atrial dimension 4.5±0.6cm. Patients with sources had a higher CHA2DS2-VASc score than those with no sources (2.74±1.50 v. 2.07±1.31, p=0.018), and patients with high EG Flow had a higher CHA2DS2-VASc score than those with low EG Flow (2.90±1.22 v. 2.23±1.54, p=0.004). One-year recurrence rates after PVI-only were higher among patients with extra-PV sources v. no sources (63% v. 35%, p=0.039) and with low EG Flow v. high EG Flow (55% v. 19%, p< 0.001). All findings were maintained when controlled for by sex. Conclusion: The presence of extra-PV sources and high EG Flow indicative of healthy atrial substrate ,are associated with significantly higher CHA2DS2-VASc scores despite an opposite effect on AF recurrence. EGF phenotyping may therefore reflect underlying pathophysiologic mechanisms and may share vascular endothelial damage and hypercoagulability as common causes with AF source formation. Atrial conduction abnormalities however arise more commonly through an independent mechanism that is not linked to increased stroke risk.

Volume

22

Issue

4 Suppl

First Page

S257

Comments

Heart Rhythm Society Annual Meeting, April 24-27, 2025, San Diego, CA

Last Page

S258

DOI

10.1016/j.hrthm.2025.03.540

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