Spatial Relationship Between Atrial Fibrillation Drivers and the Presence of Repetitive Conduction Patterns Using Recurrence Analysis on In-Silico Models

Catheter ablation treatment for atrial fibrillation (AF) is still suboptimal, possibly due to the difficulty to identify AF drivers. Recurrence analysis can be used to detect and eventually locate repetitive patterns that tend to be generated by AF drivers. In this study, we aimed to understand the spatial relationship between repetitiveness in recurrence analysis and rotor positions in an in-silico AF model. AF was simulated in a detailed three-dimensional model of the atria considering different degrees of endomysial fibrosis (0% and 70%). Rotors driving AF were tracked based on phase singularities obtained from transmembrane potentials. Activation-phase signals calculated from electrograms (4x4 electrode grid, 3 mm spacing) were used for recurrence analysis. Intervals with and without longlasting sources inside the electrode coverage area were determined; the recurrence in both groups of intervals was quantified and compared with each other by calculating the recurrence rate (RR) per AF cycle length. RRs were lower during intervals with sources for both 0% and 70% fibrosis groups (0.56 [0.36;0.85] vs. 0.90 [0.80;0.97], p < 0:001 and 0.73 [0.41;0.84] vs. 0.87 [0.76;0.92], p < 0:001, respectively). These results indicate that recurrences are found in the area adjacent to the sources but not on the sources themselves, thus suggesting that recurrence analysis could contribute to guide ablation therapy.