Po-03-102 biatrial characterization of artificial-intelligence identified spatiotemporal dispersion in persistent atrial fibrillation

Spatiotemporal dispersion is an electrical footprint of atrial fibrillation (AF) drivers that has been implemented to target extra-pulmonary veins (PVs) regions during persistent AF ablation. Characterize the level of spatiotemporal dispersion extent and whether it is associated with differential acute and long-term AF ablation outcomes. Spatiotemporal dispersion maps were built with an artificial intelligence (AI) software (VX1, Volta Medical) and analyzed in 72 consecutive persistent (65%), and long-standing persistent (35%) AF patients admitted for a first ablation procedure. An automated quantification of dispersion extent was conducted in three steps: (i) a gradient filter was applied, (ii) dispersion areas were segmented and (iii) segmented dispersion areas were connected. Three groups of patients were defined: low dispersion (group 1, first quartile, n=18), medium dispersion (group 2, between quartile 1 and 3, n=36) and high dispersion (group 3, third quartile, n=18). The dispersion extent was higher in the left atrium compared to the right atrium (14.0 ± 8.7 % versus 1.6 ± 1.8 % P<0.0001). All patients (100%) had dispersion in the left atrium, while dispersion was present in 65 % of the patients in the right atrium. Overall, ablation performed following the AI-software adjudications led to AF termination in 82% of the patients after 30 ± 17 min. Importantly, the rates of AF termination by ablation were similar between groups: 83%, 81% and 83% for Groups 1, 2 and 3, respectively (p=0.954). Also, at 13.5 months, freedom from AF after 1 procedure (88%, 81% and 100% in Groups 1, 2 and 3, respectively, p=0.321) and freedom from any atrial arrhythmia after multiple procedure (88%, 75% and 91% in Groups 1, 2 and 3, respectively, p=0.517) were similar between groups (see Figure). AI-adjudicated, dispersed electrograms atrial extent does not associate with differential acute and long-term outcomes after the ablation of persistent atrial fibrillation.