ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2026
Electrographic flow (EGF) mapping reveals sex-based differences in EGF patterns with women concentrated in phenotypes that benefit from EGF-guided ablation.
Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 1 paper.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Randomized Controlled Study to Evaluate the Reliability of Electrographic Flow™ (EGF) Mapping Algorithm Technology to Identify Sources of Atrial Fibrillation and Guide Ablation Therapy in Patients With Persistent Atrial Fibrillation
A Post Market, Global Registry to Evaluate the Identification of Atrial Fibrillation Sources Using Electrographic Flow (EGF™) Mapping System to Guide Ablation Therapy in Patients With Atrial Fibrillation in Real-world Setting.
Electrographic Flow Mapping Electrogram Validation in Patients With Persistent Atrial Fibrillation (FLOW EVAL-AF)
Who cites it
1 citing paper in PubMed.
- Evaluation and Classification of Atrial Arrhythmias from Signatures in Electrographic Flow Metrics.The Journal of innovations in cardiac rhythm management · 2026Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundElectrographic flow (EGF) mapping allows for the near real-time visualization of atrial wavefront propagation. Two factors have been found to be associated with higher rates of atrial fibrillation (AF) recurrence: presence of active extra-pulmonary vein (PV) sources and low electrographic flow consistency (EGFC) representing chaotic flow and abnormal atrial substrate. Based on these characteristics, EGF phenotypes have been identified: Type I patients have no sources + high EGFC, Type II have sources + high EGFC, Type III have sources + low EGFC, and Type IV have no sources + low EGFC.
objectiveDetermine the sex differences in EGF phenotypes and post-ablation outcomes.
methodsPatients were pooled from three prospective clinical trials: FLOW-AF, EVAL-AF, and the AF-FLOW Global Registry. From these trials, 104 persistent AF (PeAF) or long-standing PeAF patients underwent EGF mapping in 5 standardized, biatrial basket positions. Phenotyping into one of the 4 types was performed from post-PVI maps, and patients were followed for up to 12 months post-procedure, which included PVI-only and PVI + EGF-guided source ablation procedures. Outcomes were compared by chi-square tests, z-tests of proportions, logistic regression, and cox proportional models.
resultsThere were 30 (29%) female patients with mean age 70 ± 8 years and 74 (71%) males with mean age 64 ± 10 years. There was no significant difference in left atrial dimension, left ventricular ejection fraction, or number of prior ablations between men and women. Men and women had distinct phenotype distributions (p = 0.007). Women had more sources and higher EGFC so were more likely than men to present as Type II (43% vs. 20%, p = 0.016), including when controlling for confounders (aOR 3.17, p = 0.024). Outcomes of these Type II patients were most improved by PVI + EGF-guided ablation when compared to PVI-only (91% vs. 50%, p = 0.038) without differences in intra-phenotype responsiveness to treatment by sex or intragroup hazard ratios by sex. Trends in phenotype differences of women vs. men were also present among those with other factors that increased CHA
conclusionsFemale patients with PeAF are more likely to have extra-PV sources but healthy underlying substrate (Type II), which responds favorably to PVI + targeted source ablation. Ablation strategies should consequently target an individual's mechanism of disease. TRIAL REGISTRATION NUMBERS: FLOW-AF: NCT04473963, FLOW EVAL-AF: NCT06260670, AF-FLOW Global Registry: NCT05481359.
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