Atrial fibrillatory cycle length: computer simulation and potential clinical importance

Haı̈ssaguerre, Michel; Lim, Kang‐Teng; Jacquemet, Vincent; Rotter, M.; Dang, Lam; Hocini, Mélèze; Matsuo, Seiichiro; Knecht, Sébastien; Jaı̈s, Pierre; Virag, Nathalie

doi:10.1093/europace/eum208

Cited by 76 publications

(93 citation statements)

References 20 publications

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“…In one analysis presented by Haïssa-guerre et al, 11 patients with structural heart disease admitted for catheter ablation of AF had significantly lower AFR than those with structurally normal hearts, supporting our observation in MUSIC material. Because no information on the AF duration at inclusion in MUSIC study was collected, we have not been able to analyze whether observed AFR values correlate with the duration of the arrhythmia, which is a limitation of our study.…”

Section: Afr In Af Intervention Studies and Findings In Music Af Cohortsupporting

confidence: 88%

“…Clinical observations confirmed these findings, 10 and the link between slower AFR and better outcome of interventions for persistent AF have been reported, both for cardioversion 4 and catheter ablation of AF. 7,11 However, refractoriness of atrial myocytes is not the only determinant of AFR. Ablation in the left atrium that creates boundaries hindering propagation of fibrillatory waves prolongs the AF cycle length measured in the right atrial appendage.…”

Section: Age-related Afr Slowingmentioning

confidence: 99%

“…Ablation in the left atrium that creates boundaries hindering propagation of fibrillatory waves prolongs the AF cycle length measured in the right atrial appendage. 11 AFR obtained from surface ECG is a composite measure that reflects fibrillatory process in the atria rather than a local AF cycle length. Slowing of AFR, therefore, can be explained by a combination of factors that include reduced firing of focal AF sources, lower number of circulating wavelets, increase in atrial refractory period, or slowing of atrial conduction.…”

Section: Age-related Afr Slowingmentioning

confidence: 99%

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Low Atrial Fibrillatory Rate Is Associated With Poor Outcome in Patients With Mild to Moderate Heart Failure

Platonov

Cygankiewicz

Stridh

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Background-Atrial fibrillatory rate (AFR) is a measure of atrial remodeling caused by atrial fibrillation (AF), and its acceleration negatively affects outcome of interventions for persistent AF. However, the prognostic value of AFR in patients with congestive heart failure (CHF) has not been studied. We sought to evaluate whether AFR can predict outcome in patients with mild to moderate (New York Health Association II-III) CHF. Methods and Results-High-resolution 20-minute long Holter ECGs obtained from 169 CHF patients with AF at enrollment were analyzed. AFR was estimated using spatiotemporal QRST cancellation and time-frequency analysis. The patients were followed for a median of 44 months, with primary end point defined as total mortality and secondary end points as sudden death and heart failure death. Atrial signal quality was sufficient for AFR estimation in 142 patients (mean age 69Ϯ11 years, 101 male). Of those, 48 patients died during follow-up, including 18 because of CHF progression. Mean AFR was 390Ϯ60 fpm and decreased with age (rϭϪ0.3, PϽ0.001). Patients with AFR Յ371 fpm (lower tertile) had 44% 3-year mortality as compared with 26% with higher AFR. Lower AFR was an independent predictor of all cause mortality (HRϭ1.99, 95% CIϭ1.09 -3.63, Pϭ0.025) and CHF death (HRϭ3.74, 95% CIϭ1.38 -10.14, Pϭ0.010) after adjustment for significant clinical covariates in multivariable Cox analysis. Conclusions-In CHF patients with AF, reduced AFR assessed using noninvasive approach is associated with increased risk of death because of heart failure progression, and may be considered a predictor of outcome. (Circ Arrhythm Electrophysiol. 2012;5:77-83.)

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Section: Afr In Af Intervention Studies and Findings In Music Af Cohortsupporting

confidence: 88%

Section: Age-related Afr Slowingmentioning

confidence: 99%

Section: Age-related Afr Slowingmentioning

confidence: 99%

See 1 more Smart Citation

Low Atrial Fibrillatory Rate Is Associated With Poor Outcome in Patients With Mild to Moderate Heart Failure

Platonov

Cygankiewicz

Stridh

et al. 2012

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

“…19 AFCL is inversely proportional to the number of drivers maintaining AF, and hence AFCL prolongation is thought to reflect elimination of drivers. 20 AFCL has been used by others to monitor response to ablation, with an increase Ն5-6 ms considered significant. [21][22][23] Mean AFCL was determined manually over 30 cycles from bipolar electrograms recorded at the apex of the left and right atrial appendages, where electrograms are high-voltage and hence AFCL is unambiguous, before and after ablation of each CFAE lesion.…”

Section: Assessment Of Afclmentioning

confidence: 99%

Left Atrial Wall Stress Distribution and Its Relationship to Electrophysiologic Remodeling in Persistent Atrial Fibrillation

Hunter

Liu²,

Lu³

et al. 2012

Circ: Arrhythmia and Electrophysiology

103

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Background-Atrial stretch causes remodeling that predisposes to atrial fibrillation. We tested the hypothesis that peaks in left atrial (LA) wall stress are associated with focal remodeling. Methods and Results-Nineteen patients underwent LA mapping before catheter ablation for persistent atrial fibrillation.Finite Element Analysis was used to predict wall stress distribution based on LA geometry from CT. The relationship was assessed between wall stress and (1) electrogram voltage and (2) complex fractionated atrial electrograms (CFAE), using CFAE mean (the mean interval between deflections). Wall stress varied widely within atria and between subjects (median, 36 kPa; interquartile range, 26 -51 kP). Peaks in wall stress (Ն90th percentile) were common at the pulmonary vein (PV) ostia (93%), the appendage ridge (100%), the high posterior wall (84%), and the anterior wall and septal regions (42-84%). Electrogram voltage showed an inverse relationship across quartiles for wall stress (19% difference across quartiles, Pϭ0.016). There was no effect on CFAE mean across quartiles of wall stress. Receiver operating characteristic analysis showed high wall stress was associated with low voltage (ie, Ͻ0.5 mV) and electrical scar (ie, Ͻ0.05 mV; both PϽ0.0001) and with absence of CFAE (ie, CFAE mean Ͻ120 ms; PϽ0.0001). However, peaks in wall stress and CFAE were found at 88% of PV ostia. Conclusions-Peaks in wall stress were associated with areas of low voltage, suggestive of focal remodeling. Although peaks in wall stress were not associated with LA CFAE, the PV ostia may respond differently. (Circ Arrhythm Electrophysiol. 2012;5:351-360.)

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“…If AF does not terminate or is re-inducible after termination, we assess for AF cycle length prolongation >10 %, that indicates elimination of a secondary AF source in our studies and in prior computer simulations (that used a more lenient 3-4 % cutpoint). 46,47 We then used a composite acute endpoint of 'hyperacute' AF termination (with non-re-inducibility) or ≥10 % slowing.…”

Section: Targeted Ablation Only At Rotors and Focal Sources Acutely Tmentioning

confidence: 99%

Targeting Stable Rotors to Treat Atrial Fibrillation

Narayan¹,

Krummen

2012

Arrhythmia &Amp; Electrophysiology Review

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Therapy for atrial fibrillation (AF) remains suboptimal, in large part because its mechanisms are unclear. While pulmonary vein ectopy may trigger AF, it remains uncertain how AF, once triggered, is actually sustained. Recent discoveries show that human AF is maintained by a small number of rotors or focal sources. AF sources are widely distributed in patient-specific locations, often remote from pulmonary veins and in the right atrium and stable for prolonged periods of time. In a multicentre experience, brief targeted ablation at sources (focal impulse and rotor modulation [FIRM]) terminated AF predominantly to sinus rhythm prior to pulmonary vein isolation and eliminated AF on rigorous followup. This review summarises the evidence for stable rotors and focal sources of human AF and their clinical role as ablation targets to eliminate paroxysmal, persistent and long-standing persistent AF.

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Atrial fibrillatory cycle length: computer simulation and potential clinical importance

Cited by 76 publications

References 20 publications

Low Atrial Fibrillatory Rate Is Associated With Poor Outcome in Patients With Mild to Moderate Heart Failure

Low Atrial Fibrillatory Rate Is Associated With Poor Outcome in Patients With Mild to Moderate Heart Failure

Left Atrial Wall Stress Distribution and Its Relationship to Electrophysiologic Remodeling in Persistent Atrial Fibrillation

Targeting Stable Rotors to Treat Atrial Fibrillation

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