Driver Domains in Persistent Atrial Fibrillation
Top Cited Papers
- 12 August 2014
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 130 (7), 530-538
- https://doi.org/10.1161/circulationaha.113.005421
Abstract
Background— Specific noninvasive signal processing was applied to identify drivers in distinct categories of persistent atrial fibrillation (AF). Methods and Results— In 103 consecutive patients with persistent AF, accurate biatrial geometry relative to an array of 252 body surface electrodes was obtained from a noncontrast computed tomography scan. The reconstructed unipolar AF electrograms acquired at bedside from multiple windows (duration, 9±1 s) were signal processed to identify the drivers (focal or reentrant activity) and their cumulative density map. The driver domains were catheter ablated by using AF termination as the procedural end point in comparison with the stepwise-ablation control group. The maps showed incessantly changing beat-to-beat wave fronts and varying spatiotemporal behavior of driver activities. Reentries were not sustained (median, 2.6 rotations lasting 449±89 ms), meandered substantially but recurred repetitively in the same region. In total, 4720 drivers were identified in 103 patients: 3802 (80.5%) reentries and 918 (19.5%) focal breakthroughs; most of them colocalized. Of these, 69% reentries and 71% foci were in the left atrium. Driver ablation alone terminated 75% and 15% of persistent and long-lasting AF, respectively. The number of targeted driver regions increased with the duration of continuous AF: 2 in patients presenting in sinus rhythm, 3 in AF lasting 1 to 3 months, 4 in AF lasting 4 to 6 months, and 6 in AF lasting longer. The termination rate sharply declined after 6 months. The mean radiofrequency delivery to AF termination was 28±17 minutes versus 65±33 minutes in the control group (PP=not significant. Conclusions— Persistent AF in early months is maintained predominantly by drivers clustered in a few regions, most of them being unstable reentries.This publication has 29 references indexed in Scilit:
- Inverse Relationship Between Fractionated Electrograms and Atrial Fibrosis in Persistent Atrial Fibrillation: Combined Magnetic Resonance Imaging and High-Density MappingJournal of the American College of Cardiology, 2013
- Noninvasive Panoramic Mapping of Human Atrial Fibrillation Mechanisms: A Feasibility ReportJournal of Cardiovascular Electrophysiology, 2013
- High Density Mapping of Atrial Fibrillation During Vagal Nerve Stimulation in the Canine Heart: Restudying the Moe HypothesisJournal of Cardiovascular Electrophysiology, 2012
- Treatment of Atrial Fibrillation by the Ablation of Localized Sources: CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) TrialJournal of the American College of Cardiology, 2012
- Recent advances in the molecular pathophysiology of atrial fibrillationJCI Insight, 2011
- Fibrillatory Conduction in the Atrial Free Walls of Goats in Persistent and Permanent Atrial FibrillationCirculation: Arrhythmia and Electrophysiology, 2010
- Noninvasive Characterization of Epicardial Activation in Humans With Diverse Atrial Fibrillation PatternsCirculation, 2010
- Long‐Term Outcome of Atrial Fibrillation Ablation: Impact and Predictors of Very Late RecurrenceJournal of Cardiovascular Electrophysiology, 2010
- Disparate Evolution of Right and Left Atrial Rate During Ablation of Long-Lasting Persistent Atrial FibrillationJournal of the American College of Cardiology, 2010
- Rotor meandering contributes to irregularity in electrograms during atrial fibrillationHeart Rhythm, 2008