Atrial fibrillation (AF) is a common heart rhythm disorder. While catheter ablation is an effective treatment, many patients still experience AF recurrence after the procedure. One major reason is that the mechanisms that maintain AF are not fully understood. Research suggests that the outer layer of the heart (epicardium) may play an important role in keeping AF going. However, current mapping techniques have limitations in detecting electrical signals from both the inner and outer heart layers.
This study uses a different technique called unipolar voltage mapping, which may more accurately capture electrical signals from both heart layers. Specifically, we focus on a specific type of electrical signal called "QS potential" on unipolar mapping, which reflects breakthrough sites between the inner and outer heart layers.
In this interventional study, participants with AF undergoing catheter ablation will receive personalized ablation guided by unipolar QS-potential mapping. We aim to:
Explore the relationship between unipolar QS-potentials and AF maintenance and atrial remodeling Evaluate the effectiveness of QS-potential guided personalized AF ablation
Age ≥ 18 years and ≤ 80 years
Documented diagnosis of atrial fibrillation (paroxysmal or persistent)
Planned to undergo catheter ablation for AF (including patients with recurrent AF after prior ablation)
Able and willing to provide written informed consent
Left ventricular ejection fraction < 35%
Severe valvular heart disease (moderate to severe mitral stenosis or regurgitation)
History of intracardiac thrombus
Contraindication to anticoagulation
Parallel
Unipolar QS-Potential Guided Catheter Ablation
Procedure/SurgeryParticipants in this arm undergo catheter ablation for atrial fibrillation guided by unipolar QS-potential mapping. Intracardiac unipolar voltage mapping is performed to identify QS-potentials, which reflect epicardial-endocardial breakthrough sites. Ablation is delivered to these identified target sites in addition to standard pulmonary vein isolation.
Conventional Pulmonary Vein Isolation
Procedure/SurgeryParticipants in this arm undergo conventional pulmonary vein isolation for atrial fibrillation using standard bipolar voltage mapping. Ablation is performed to achieve electrical isolation of the pulmonary veins, without additional mapping-guided ablation beyond PVI.
Freedom from Atrial Fibrillation Recurrence at 3 Months Post Ablation
Freedom from any episode of atrial fibrillation (AF), atrial tachycardia (AT), or atrial flutter (AFL) lasting ≥30 seconds, as detected by electrocardiogram (ECG) or 24-hour Holter monitoring, after a 3-month blanking period following the ablation procedure.
Total ablation time
Total duration of radiofrequency energy delivery during the ablation procedure, measured in minutes. This includes all ablation applications (both pulmonary vein isolation and additional lesion sets) from the first to the last energy application.
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