Non-invasive 3D Electromechanical Cycle Length Mapping for Atrial Fibrillation Mapping and PVI Ablation Response Prediction

Source-agnostic pulmonary vein isolation (PVI) success rate for first-time Atrial Fibrillation (AF) ablation remains 50-70%, requiring additional procedures upon recurrence. This study investigates the potential of Electromechanical Cycle Length Mapping (ECLM), a high-frame-rate, noninvasive 2D ultrasound technique, for mapping and quantifying atrial fibrillation (AF) electromechanical cycle length (CL) activity, and its use in predicting long-term outcomes following ablation procedures. Fifteen AF patients were imaged before and after their first successful cardiac ablation. Pre-ablation ECLM maps accurately identified arrhythmic trigger locations in all patients, with a noticeable reduction post-ablation. During follow-up, seven patients experienced AF recurrence within three months. Pre-ablation CL dispersion was found to be an independent predictor of this recurrence (multivariate logistic regression, AUC = 0.81). These results highlight ECLM's potential for immediate arrhythmia assessment and predicting treatment response at the time of diagnosis.