Atrial Fibrillation Global Changes after Pulmonary Vein and Posterior Wall Isolation: A Charge Density Mapping Study

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BACKGROUND: Non-contact charge density (CD) mapping allows a global visualization of left atrium (LA) activation and of activation patterns during atrial fibrillation (AF). The aim of this study was to analyze, with CD mapping, the changes in persistent AF induced by pulmonary vein isolation (PVI) and LA posterior wall isolation (LAPWI).

METHODS: Patients undergoing PVI + LAPWI using the Arctic Front Advance PROTM cryoballoon system were included in the study. CD maps were created during AF at baseline, after PVI and after LAPWI. Three distinct activation patterns were identified in the CD maps: localized irregular activation (LIA), localized rotational activation (LRA) and focal centrifugal activation (FCA). LA maps were divided into the following regions: anterior, septal, lateral, roof, posterior, inferior.

RESULTS: Eleven patients were included, with a total of 33 maps and 198 AF regions analyzed. Global and regional AF cycle lengths significantly increased after PVI and LAPWI. Baseline analysis demonstrated higher LIA, LRA and FCA numbers in the posterior and anterior regions. After PVI, there was no change in LIA, LRA and FCA occurrence. After PVI + LAPWI, a significant decrease in LRA was observed with no difference in LIA and FCA occurrence. In the regional analysis, there was a significant reduction in the LIA number in the inferior region, in the LRA number in the roof and posterior regions and in the FCA number in the lateral region.

CONCLUSIONS: A global reduction in the LRA number was observed only after PVI + LAPWI; it was driven by a reduction in rotational activity in the roof and posterior regions.

Original languageEnglish
Article number2948
Number of pages11
JournalJournal of clinical medicine
Issue number10
Publication statusPublished - May 2022

Bibliographical note

Funding Information:
This research has been partially funded by the Academy of Finland (project #211025). The first author acknowledges the financial support from Helsinki Graduate School in Computer Science and Engineering, Nokia Foundation, and Finnish Cultural Foundation.

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Copyright 2022 Elsevier B.V., All rights reserved.


  • atrial fibrillation
  • charge density
  • posterior wall isolation
  • pulmonary vein isolation


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