Biatrial and Three‐Dimensional Mapping of Spontaneous Atrial Arrhythmias in Patients with Refractory Atrial Fibrillation

Saksena, Sanjeev; Skadsberg, Nicholas D.; Rao, Hygriv B.; Filipecki, Artur

doi:10.1111/j.1540-8167.2005.40531.x

Cited by 57 publications

(35 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistent with these observations, detailed mapping in AF patients showed that organized monomorphic AFL commonly occurred before paroxysmal AF. 20 In addition, the regional distribution of organized monomorphic atrial arrhythmias was more extensive in patients with structural heart disease and persistent AF compared with patients without structural heart disease or paroxysmal AF. 20 Therefore, these results support the clinical observation that AFL is induced preferably by focal discharges for a normal spatial dispersion of atrial refractoriness, whereas AF is more likely to be induced when the dispersion is increased, 21 such as due to atrial inflammation or structural heart diseases.…”

Section: L-type Ca 2؉ Current and Restitution Propertiesmentioning

confidence: 98%

“…This is consistent with a detailed mapping study that showed that organized monomorphic atrial tachyarrhythmias induced by premature beats could first arise from the RA, interatrial region, or LA in patients with AF. 20 Moreover, for ectopic foci in the RA, especially those closer to the sinoatrial node such as the superior vena cava and crista terminalis, the size of the vulnerable window for the induction of AFL/AF became markedly smaller than that of the PV ectopic foci ( Figure 4B). The effect of increasing vulnerable window size when increasing the distance between 2 pacing sites (in this case sinoatrial node and ectopic focus) has been attributed to a physical principle known as symmetry breaking, 10,14 as described in Dynamic Repolarization Dispersion and Conduction Block in Results.…”

Section: Atrial Fibrillationmentioning

confidence: 99%

See 1 more Smart Citation

Mechanism Underlying Initiation of Paroxysmal Atrial Flutter/Atrial Fibrillation by Ectopic Foci

et al. 2007

View full text Add to dashboard Cite

Background-The mechanisms underlying paroxysmal atrial flutter/atrial fibrillation initiation by ectopic foci from various locations are unclear. Methods and Results-We used parallel computational techniques to study an anatomically accurate 3-dimensional atrial structure incorporating a detailed ionic-current model of an atrial myocyte. At the single-cell level, upregulation of the L-type Ca 2ϩ current I Ca,L steepened restitution curves of action potential duration and conduction velocity compared with the control. Spontaneous firings of ectopic foci, coupled with sinus activity, produced dynamic spatial dispersions of repolarization, including discordant alternans, which caused conduction block and reentry only for the elevated I Ca,L case. For each foci location, a vulnerable window for atrial flutter/atrial fibrillation induction was identified as a function of the coupling interval and focus cycle length. For ectopic foci in the pulmonary veins and left atrium, the site of conduction block and reentry gradually shifted, as a function of coupling interval, from the right atrium to the interatrial area and finally to the left atrium. The size of the vulnerable window was largest for pulmonary vein foci, becoming markedly smaller for right atrial foci, especially those near the sinoatrial node. Conclusions-These findings suggest that a mechanism of dynamically induced repolarization dispersion, especially discordant alternans, underlies the induction of atrial flutter/atrial fibrillation by atrial ectopic foci. The sites and likelihood of reentry induction varied according to ectopic focus location and timing, with the largest vulnerable window corresponding to the pulmonary vein region.

show abstract

Section: L-type Ca 2؉ Current and Restitution Propertiesmentioning

confidence: 98%

Section: Atrial Fibrillationmentioning

confidence: 99%

Mechanism Underlying Initiation of Paroxysmal Atrial Flutter/Atrial Fibrillation by Ectopic Foci

et al. 2007

View full text Add to dashboard Cite

show abstract

“…These data are in agreement with the different frequency gradients, 43 and spatiotemporal organization in paroxysmal AF patients compared with persistent AF patients. 44 Parasympathetic signaling is altered in human atrial myocytes obtained from chronic AF patients. Data indicate that the short APD and reduced APD response to changes in activation frequency that characterize chronic AF correlated with reduced I Ca-L and increased I K1 and I K,ACh .…”

Section: Electrical and Structural Remodeling And Rotorsmentioning

confidence: 99%

Cardiac fibrillation: From ion channels to rotors in the human heart

Vaquero¹,

Calvo²,

Jalife³

2008

Heart Rhythm

158

134

View full text Add to dashboard Cite

Cardiac fibrillation is one of the most important causes of morbidity and mortality in the developed world, but its mechanisms are still a matter of debate. Not only is the role of certain ion channels currently being unraveled, but also investigators are starting to gather evidence for the dynamics and molecular mechanisms of both atrial (AF) and ventricular (VF) fibrillation in humans. In this brief review, we evaluate the available evidence for the separate roles played by individual sarcolemmal ion channels in AF and VF, assessing the clinical relevance of such findings. Importantly, while human data support the idea that rotors are a crucial mechanism for fibrillation maintenance in both the atria and the ventricles, there are clear inherent differences between the two chamber types, particularly in regards to the role of specific ion channels in fibrillation. But there are also similarities. This knowledge, together with new information on the changes that take place during disease evolution and between structurally normal and diseased hearts may enhance our understanding of fibrillatory processes pointing to new pharmacological or interventionist approaches to improve disease outcomes.

show abstract

“…Today, debate centers on the DANISH trial challenging defibrillator benefits in a large segment of the ventricular dysfunction population [1]. Biatrial mapping in atrial fibrillation performed by a few groups two decades ago suggested biatrial triggers and tachycardias that had been in disfavor for this epoch, now have returned to center stage with new mapping technology [2][3][4]. This has initiated a major pendulum swing in ablation therapy beyond the pulmonary vein triggers and tachycardias.…”

mentioning

confidence: 99%

Biatrial and Three‐Dimensional Mapping of Spontaneous Atrial Arrhythmias in Patients with Refractory Atrial Fibrillation

Cited by 57 publications

References 31 publications

Mechanism Underlying Initiation of Paroxysmal Atrial Flutter/Atrial Fibrillation by Ectopic Foci

Mechanism Underlying Initiation of Paroxysmal Atrial Flutter/Atrial Fibrillation by Ectopic Foci

Cardiac fibrillation: From ion channels to rotors in the human heart

Festina Lente—a curiously apt aphorism for Interventional Cardiac Electrophysiology in 2018

Contact Info

Product

Resources

About