Prognosticative Electrographic Flow (EGF) Metrics Correlate With Temporal Persistence of AF Episodes in RESOLVE-AF

Document Type

Conference Proceeding

Publication Date

4-2026

Publication Title

Heart Rhythm

Abstract

Background: Electrographic flow (EGF) mapping is an diagnostic tool for visualizing atrial activation patterns in atrial fibrillation (AF). Its clinical efficacy in detecting AF sources was demonstrated in the FLOW-AF randomized controlled trial (NCT04473963). Patients were phenotyped based on the presence or absence of EGF identified sources and their Electrographic Flow Consistency (EGFC), a measure of wavefront stability through the substrate. Type I patients have no sources + high EGFC; Type II have sources + high EGFC; Type III have sources + low EGFC; Type IV have no sources + low EGFC. The ability of EGF mapping to determine disease mechanisms was further studied in the larger patient population in RESOLVE-AF (NCT05883631). Objective: Establish a relationship between EGF metrics and temporal persistence of AF episodes. Methods: RESOLVE-AF enrolled 330 patients across 25 clinical centers in the US and EU for redo or de novo ablation. In spontaneous and inducible AF patients, unipolar electrograms were recorded for 1 minute from a 64-pole basket mapping catheter to generate baseline EGF maps in AF prior to any source ablation. Patients were mapped in a minimum of 5 standardized positions to achieve full endocardial coverage. Results: A total of 246 patients had index procedures and received complete EGF mapping in AF: 105 de novo AF patients with age 6669 years, 30% female sex and left atrial (LA) size 4.161.3 cm; 141 redo AF patients with age 67610 years, 31% female sex and LA size 3.761.9 cm. Overall, 22% had paroxysmal AF (PAF), 72% had persistent AF (PersAF) and 7% had long-standing PersAF (LSPersAF). Source count was the same in patients with PAF and PersAF (2.561.8 vs. 2.561.5, p50.86) but was higher for LSPersAF compared to PersAF (3.661.2 vs 2.561.5, p50.007). EGFC was higher for PAF than PersAF patients (0.7060.18 vs. 0.6260.17, p50.004) as well as for PersAF compared to LS-PeAF (0.6260.17 vs. 0.5260.11, p50.025). There were no significant differences between de novo and redo source count or EGFC in any AF type (p.0.10).Among PAF patients, 58% were Type I or Type II vs. 39% PeAF patients and 31% LS-PeAF patients (p50.025). Conclusion: EGFC decreases with increasing temporal persistence of AF episodes, showing a higher complexity of the atrial substrate with advancing AF.

Volume

23

Issue

4 Suppl

First Page

S542

Comments

Heart Rhythm Society Annual Meeting, April 23-26, 2026, Chicago, IL

Last Page

S542

DOI

10.1016/j.hrthm.2026.03.820

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