Frequency Gradient Within Coronary Sinus Predicts the Long‐Term Outcome of Persistent Atrial Fibrillation Catheter Ablation by Xiaomeng Yin, Ziming Zhao,

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Frequency Gradient Within Coronary Sinus Predicts the Long‐Term Outcome of Persistent Atrial Fibrillation Catheter Ablation by Xiaomeng Yin, Ziming Zhao, Lianjun Gao, Dong Chang, Xianjie Xiao, Rongfeng Zhang, Qi Chen, Jie Cheng, Yanzong Yang, Yutao Xi, and Yunlong Xia J Am Heart Assoc Volume 6(3):e004869 March 2, 2017 © 2017 Xiaomeng Yin et al.

Typical CARTO 3D map images and tracings from a patient with sequential stepwise ablation in anteroposterior (AP) and posteroanterior (PA) views. Typical CARTO 3D map images and tracings from a patient with sequential stepwise ablation in anteroposterior (AP) and posteroanterior (PA) views. Lasso mapping was implemented to obtain bipolar electrograms from pulmonary vein (PV) ostia, left atrial appendage (LAA), the roof of left atrium, as well as posterior and anterior parts of left atrium. The models of left atria and PVs were created by Lasso catheter in AP (left) and PA (right) positions. LA indicates left atrium; LIPV, left inferior PV; LSPV, left superior PV; RIPV, right inferior PV; RSPV, right superior PV. Xiaomeng Yin et al. J Am Heart Assoc 2017;6:e004869 © 2017 Xiaomeng Yin et al.

Typical CARTO 3D map images and tracings from a patient with stepwise ablation in left anterior oblique and anteroposterior (AP) views. Typical CARTO 3D map images and tracings from a patient with stepwise ablation in left anterior oblique and anteroposterior (AP) views. Lasso mapping was implemented to obtain bipolar electrograms from the proximal and distal coronary sinus (CS), the superior vena cava (SVC), as well as the crista terminal of the right atrium. The models of right and left atria were created by a Lasso catheter in left anterior oblique 45° (left) and AP (right) positions. CSd and CSp respectively indicate distal and proximal coronary sinus. Xiaomeng Yin et al. J Am Heart Assoc 2017;6:e004869 © 2017 Xiaomeng Yin et al.

A, The models of the coronary sinus (CS) and left atrium were created by Lasso catheters in the left anterior oblique 45° (left) and left lateral positions. A, The models of the coronary sinus (CS) and left atrium were created by Lasso catheters in the left anterior oblique 45° (left) and left lateral positions. B, The difference of electrical activity within the CS. C, Persistent atrial fibrillation converts to SR after CS potential was ablated. CSp indicates proximal CS; LA, left atrium; SR, sinus rhythm. Xiaomeng Yin et al. J Am Heart Assoc 2017;6:e004869 © 2017 Xiaomeng Yin et al.

Scatterplot showing the (A) frequency in the proximal coronary sinus (CSp) and (C) the distal coronary sinus (CSd) ratio (CSd/CSp ratio) before catheter ablation, Horizontal line indicates optimal diagnostic cutoff value to predict termination of ... Scatterplot showing the (A) frequency in the proximal coronary sinus (CSp) and (C) the distal coronary sinus (CSd) ratio (CSd/CSp ratio) before catheter ablation, Horizontal line indicates optimal diagnostic cutoff value to predict termination of atrial fibrillation. Receiver‐operator characteristics (ROC) curve analysis with (B) frequency in the CSp and (D) the ratio of the frequency of CSd/CSp. Arrows shows optimal cutoff point for sensitivity and specificity. CS indicates coronary sinus; PV indicates pulmonary vein. Xiaomeng Yin et al. J Am Heart Assoc 2017;6:e004869 © 2017 Xiaomeng Yin et al.

Kaplan‐Meier survival curves plotted to assess clinical outcomes of ablation for persistent atrial fibrillation according to distal frequency/proximal frequency cutoff values. Kaplan‐Meier survival curves plotted to assess clinical outcomes of ablation for persistent atrial fibrillation according to distal frequency/proximal frequency cutoff values. CSd indicates distal coronary sinus; CSp, proximal coronary sinus. Xiaomeng Yin et al. J Am Heart Assoc 2017;6:e004869 © 2017 Xiaomeng Yin et al.