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. 2019 Aug 29;125(6):609–627. doi: 10.1161/CIRCRESAHA.119.314930

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© 2019 The Authors.

Circulation Research is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.

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Figure 8. — Translation ability of the instantaneous frequency modulation (iFM)/instantaneous amplitude modulation (iAM) approach to patients with persistent atrial fibrillation (PersAF) despite ≥1 previous pulmonary vein isolation procedures. A, Map from a patient undergoing a third AF ablation procedure. Fast and large leading-driver regions covered a considerable portion of the atria and precluded a limited ablation strategy (fuchsia dashed line) from acutely terminating PersAF. Moreover, radiofrequency delivery did not modify atrial activation rates on the 12-lead ECG. B, Map from a patient with a well-delimited leading-driver region. Targeting that region with radiofrequency delivery for ≈10 min successfully terminated PersAF. Upon reinduction, common atrial flutter was the only inducible arrhythmia, which was eventually terminated by creating a linear lesion at the cavotricuspid isthmus. Abl indicates ablation; DF, dominant frequency; RF, radiofrequency; Rot, rotational; and SR, sinus rhythm.