Combined Dominant Frequency and Complex Fractionated Atrial Electrogram Ablation After Circumferential Pulmonary Vein Isolation of Atrial Fibrillation

Kumagai, Koji; Sakamoto, Tamotsu; Nakamura, Keijiro; Nishiuchi, Suguru; Hayano, Mamoru; Hayashi, Tatsuya; Sasaki, Takehito; Aonuma, Kazutaka; Oshima, Shigeru

doi:10.1111/jce.12166

Cited by 43 publications

(98 citation statements)

References 27 publications

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“…These findings have remarkably changed the management and prognostics of patients with atrial fibrillation via a new procedure of catheter ablation of atrial fibrillation that is guided by CFAE mapping [33]. Recent clinical studies of guided CFAE ablation revisited the benefits and risks of this procedure and clearly suggest that further investigation on this topic is required [34–36]. Different computer simulations have also already given valuable insights into how the microstructure of cardiac tissue, specifically microfibrosis, and CFAE are related [13, 15].…”

Section: Introductionmentioning

confidence: 99%

Reentry and Ectopic Pacemakers Emerge in a Three-Dimensional Model for a Slab of Cardiac Tissue with Diffuse Microfibrosis near the Percolation Threshold

Alonso¹,

Santos²,

Bär³

2016

PLoS ONE

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Arrhythmias in cardiac tissue are generally associated with irregular electrical wave propagation in the heart. Cardiac tissue is formed by a discrete cell network, which is often heterogeneous. Recently, it was shown in simulations of two-dimensional (2D) discrete models of cardiac tissue that a wave crossing a fibrotic, heterogeneous region may produce reentry and transient or persistent ectopic activity provided the fraction of conducting connections is just above the percolation threshold. Here, we investigate the occurrence of these phenomena in three-dimensions by simulations of a discrete model representing a thin slab of cardiac tissue. This is motivated (i) by the necessity to study the relevance and properties of the percolation-related mechanism for the emergence of microreentries in three dimensions and (ii) by the fact that atrial tissue is quite thin in comparison with ventricular tissue. Here, we simplify the model by neglecting details of tissue anatomy, e. g. geometries of atria or ventricles and the anisotropy in the conductivity. Hence, our modeling study is confined to the investigation of the effect of the tissue thickness as well as to the comparison of the dynamics of electrical excitation in a 2D layer with the one in a 3D slab. Our results indicate a strong and non-trivial effect of the thickness even for thin tissue slabs on the probability of microreentries and ectopic beat generation. The strong correlation of the occurrence of microreentry with the percolation threshold reported earlier in 2D layers persists in 3D slabs. Finally, a qualitative agreement of 3D simulated electrograms in the fibrotic region with the experimentally observed complex fractional atrial electrograms (CFAE) as well as strong difference between simulated electrograms in 2D and 3D were found for the cases where reentry and ectopic activity were triggered by the micro-fibrotic region.

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Section: Introductionmentioning

confidence: 99%

Reentry and Ectopic Pacemakers Emerge in a Three-Dimensional Model for a Slab of Cardiac Tissue with Diffuse Microfibrosis near the Percolation Threshold

Alonso¹,

Santos²,

Bär³

2016

PLoS ONE

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“…High-DF are also considered as a target of AF ablation and are reported to have some influence on the termination of paroxysmal AF. 8 In the present study, the sites of high-DF recorded during SR had fractionated electrograms, for example, a low voltage, long duration and high deflection, which may indicate slow conduction and wave collision in the LA. Atrial fibrosis is reported to be the result of LA remodeling and produces fractionated electrograms in the LA.…”

Section: Coa and High-frequency Sourcesmentioning

confidence: 94%

“…The high-DF cut-off was set at 8 Hz according to previous studies. 7, 8 The surface area of con-CFAE and high-DF was created by the NavX system and the total surface of those sites and the area of overlap with CoA were calculated and analyzed.…”

Section: Cfae and Df Mapping During Afmentioning

confidence: 99%

Influence of Left Atrium Anatomical Contact Area in Persistent Atrial Fibrillation

Hori

Kamijima

Tsukada

et al. 2014

Circ J

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“…We used a < 0.5 mV threshold for abnormally low voltage and focused on the posterior wall since the posterior wall has been targeted for ablation in other studies and has been reported to commonly harbor regions of low voltage bipolar electro grams [6,11]. This shift was an empiric one and only 3 of our 6 operators made the change in ablation strategy.…”

Section: Af Classification and Ablation Strategy: Time For A New Paramentioning

confidence: 99%

AF classification and ablation strategy: time for a new paradigm

Panda¹,

Lewis²,

Ziv³

2016

ica

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Combined Dominant Frequency and Complex Fractionated Atrial Electrogram Ablation After Circumferential Pulmonary Vein Isolation of Atrial Fibrillation

Abstract: A combined high-DF and continuous CFAE site ablation in all chambers after circumferential PVI may be effective in the paroxysmal and persistent AF patients.

Cited by 43 publications

References 27 publications

Reentry and Ectopic Pacemakers Emerge in a Three-Dimensional Model for a Slab of Cardiac Tissue with Diffuse Microfibrosis near the Percolation Threshold

Reentry and Ectopic Pacemakers Emerge in a Three-Dimensional Model for a Slab of Cardiac Tissue with Diffuse Microfibrosis near the Percolation Threshold

Influence of Left Atrium Anatomical Contact Area in Persistent Atrial Fibrillation

AF classification and ablation strategy: time for a new paradigm

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