Effect of pulmonary vein isolation on the left-to-right atrial dominant frequency gradient in human atrial fibrillation

Lazar, Sorin; Dixit, Sanjay; Callans, David J.; Lin, David; Marchlinski, Francis E.; Gerstenfeld, Edward P.

doi:10.1016/j.hrthm.2006.04.018

Cited by 66 publications

(62 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The presence of a pre-ablation LA to RA DF gradient was correlated with improved freedom from recurrence of AF after conventional PVI, and patients with recurrence of AF after PVI also had recurrence of LA to RA DF gradients at the time of repeat ablation. 31 Studies that have explored a strategy of real-time DF mapping and ablation at the site of maximal DF have resulted in improved freedom from AF recurrence. 32 It is important to realise, however, that although animal studies have correlated sites of maximal DF with rotor-like activity, it remains unclear if all sites of maximal DF represent areas of rotor-like reentry or other types of localised reentry, especially in humans.…”

Section: Evidence For Rotors and Other High Frequency Sources As Drivmentioning

confidence: 99%

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

Waks

Josephson²

2014

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

Atrial fibrillation (AF), the most common sustained arrhythmia, is a leading cause of stroke, and is associated with significant morbidity and mortality worldwide. Despite its frequency, clinical importance, and advances in technology and our knowledge of the molecular, ionic and physiological fundamentals of cardiac electrophysiology, our limited understanding of the mechanisms that initiate and sustain AF has prevented us from being able to truly cure this arrhythmia with antiarrhythmic drugs and/or ablation. This contrasts with other arrhythmias, such as AV nodal tachycardia or circus movement tachycardia using an accessory pathway, which have well-defined mechanisms and circuits that can be safely targeted with high rates of cure. The observations that AF may have different mechanisms in different patients, and that paroxysmal, persistent and permanent forms of AF may differ in how they are initiated and sustained, only serves to reinforce our lack of understanding of this ubiquitous arrhythmia. Historical Mechanisms of Atrial Fibrillation and the Multiple Wavelet HypothesisInterest and understanding of the mechanism of AF began to take form in the early 1900s. Given the chaotic and irregular nature of AF on the surface electrocardiogram, rapid firing of automatic atrial foci was considered a potential mechanism. However, after the seminal work of Mayer 1 , Mines 2 and Garrey 3 in laying the foundation for describing and understanding reentrant arrhythmias, atrial reentrant circuits emerged as the likely drivers of AF.4-7 Although these theories were conceptually sound, it was impossible to prove a specific mechanism with the technology of the time. Moe et al. demonstrated that it was probabilistically unlikely that a large number of simultaneous wavefronts would all die out simultaneously, and AF would therefore perpetuate. However, if the number of simultaneous wavelets were small and/or below a critical value (between 15 and 30 in Moe's computer model), 9 at some point all reentrant wavefronts would be simultaneously extinguished, and AF would therefore terminate. 8,9 Allessie et al. provided experimental evidence supporting this mechanism in a canine heart model of AF where four to six simultaneous reentrant wavelets were needed to sustain arrhythmia. 10 Further evidence supporting multiple wavelets in AF was demonstrated in a separate model, which evaluated the effect of various antiarrhythmic drugs on canine myocardium. This model demonstrated that termination of AF was associated with a reduction AbstractAtrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice, yet our understanding of the mechanisms that initiate and sustain this arrhythmia remains quite poor. Over the last 50 years, various mechanisms of AF have been proposed, yet none has been consistently observed in both experimental studies and in humans. Recently, there has been increasing interest in understanding how spiral waves or rotors -which are specific, organised forms of functional reentry -su...

show abstract

Section: Evidence For Rotors and Other High Frequency Sources As Drivmentioning

confidence: 99%

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

Waks

Josephson²

2014

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

show abstract

“…Previous studies showed a left to right gradient in DF in patients with paroxysmal AF but not persistent AF 18,19,39,47 . It has been found that higher DFs with lower spatiotemporal periodicity are present in patients with persistent AF 46,47 .…”

Section: Discussionmentioning

confidence: 83%

“…It has been found that higher DFs with lower spatiotemporal periodicity are present in patients with persistent AF 46,47 . In analogy, we observed higher DFs and permanent AF only in the VS group.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, an atrial electrogram can be decomposed in its spectral components creating a power spectrum where the sinusoidal wave of major amplitude Moreover, there is substantial evidence from animal and human studies that during AF dominant frequencies are higher in LA than in the RA 18,19,39,47 . According to studies in isolated sheep heart, most of the high frequency sources exist in the LA and at a critical frequency, a gradient develops between LA and RA.…”

Section: Dominant Frequencies and Afmentioning

confidence: 99%

See 1 more Smart Citation

Differences in atrial fibrillation properties under vagal nerve stimulation versus atrial tachycardia remodeling

et al. 2009

View full text Add to dashboard Cite

“…Therefore another approach that is gaining popularity is to use spectral analysis of atrial electrograms which can be helpful when presenting spatial distribution of atrial rate in arrhythmias such as AF that show some irregularity in CL or signal amplitude. (4)(5)(6)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Electrical and Mechanical Insights of Human Atrial Fibrillation

Sághy¹

View full text Add to dashboard Cite

Effect of pulmonary vein isolation on the left-to-right atrial dominant frequency gradient in human atrial fibrillation

Cited by 66 publications

References 16 publications

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

Differences in atrial fibrillation properties under vagal nerve stimulation versus atrial tachycardia remodeling

Electrical and Mechanical Insights of Human Atrial Fibrillation

Contact Info

Product

Resources

About