Electrophysiologic mechanisms of perpetuation of atrial fibrillation

Allessie, Maurits A.; Konings, Karen; Kirchhof, C; Wijffels, Maurits C.E.F.

doi:10.1016/s0002-9149(97)89114-x

Cited by 178 publications

(84 citation statements)

References 41 publications

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“…The maintenance of AF seems to depend on the presence of a sufficient number of small wavefronts while undergoing fractionation, collisions and coalescence over the atrial surface. To allow multiple re-entrant wavelets to propagate resulting in a self-perpetuating activity, a critical mass of excitable atrial tissue must exist [28]. Re-entry within the atria is associated with shortening of the ERP with increased dispersion of refractoriness, thereby providing a substrate for initiation of AF.…”

Section: Self-limited Vs Self-sustained Atrial Fibrillationmentioning

confidence: 99%

Inducibility of atrial fibrillation during electrophysiologic evaluation is associated with increased dispersion of atrial refractoriness

Oliveira

Silva

Timóteo

et al. 2009

International Journal of Cardiology

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The impact of atrial dispersion of refractoriness (Disp_A) in the inducibility and maintenance of atrial fibrillation (AF) has not been fully resolved. Aim: To study the Disp_A and the vulnerability (A_Vuln) for the induction of self-limited (b 60 s) and sustained episodes of AF. Methods and results: Forty-seven patients with paroxysmal AF (PAF): 29 patients without structural heart disease and 18 with hypertensive heart disease. Atrial effective refractory period (ERP) was assessed at five sites -right atrial appendage and low lateral right atrium, high interatrial septum, proximal and distal coronary sinus. We compared three groups: group A -AF not inducible (n = 13); group B -AF inducible, self-limited (n = 18); group C -AF inducible, sustained (n = 16). Age, lone AF, hypertension, left atrial and left ventricular (LV) dimensions, LV systolic function, duration of AF history, atrial flutter/tachycardia, previous antiarrhythmics, and Disp_A were analysed with logistic regression to determine association with A_Vuln for AF inducibility. The ERP at different sites showed no differences among the groups. Group A had a lower Disp_A compared to group B (47 ± 20 ms vs 82 ± 65 ms; p = 0.002), and when compared to group C (47 ± 20 ms vs 80 ± 55 ms; p = 0.008). There was no significant difference in Disp_A between groups B and C. By means of multivariate regression analysis, the only predictor of A_Vuln was Disp_A (p = 0.04). Conclusion: In patients with PAF, increased Disp_A represents an electrophysiological marker of A_Vuln. Inducibility of both self-limited and sustained episodes of AF is associated with similar values of Disp_A. These findings suggest that the maintenance of AF is influenced by additional factors.

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Section: Self-limited Vs Self-sustained Atrial Fibrillationmentioning

confidence: 99%

Inducibility of atrial fibrillation during electrophysiologic evaluation is associated with increased dispersion of atrial refractoriness

Oliveira

Silva

Timóteo

et al. 2009

International Journal of Cardiology

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“…Finally, the immense variability regarding the duration of AF (range 1-265 days) in that study could also justify the aforementioned differences, as increased AF duration promotes structural and electrophysiological changes that potentially contribute to the persistence of AF. 29 The impact of IL-6 and TNF-a on AF also remains questionable. An earlier study of patients with persistent AF who underwent direct current cardioversion failed to show any significant relation between baseline IL-6 and the incidence or cardioversion outcome of AF.…”

Section: Discussionmentioning

confidence: 99%

Hypertension and paroxysmal atrial fibrillation: a novel predictive role of high sensitivity C-reactive protein in cardioversion and long-term recurrence

et al. 2010

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“…2,3 His hypothesis was confirmed by the work of Allessie and colleagues thirty years later, [4][5][6] when they demonstrated that sustained AF depended on functional reentry of multiple wavefronts through a critical mass of atrial tissue. At approximately the same time, Haisseguerre and colleagues demonstrated that initiation of AF was triggered by spontaneous ectopy originating from foci in the pulmonary veins(PV).…”

Section: Definition Of Pericardial Fatmentioning

confidence: 91%

Catheter Ablation for AF: Past, Present, and Future

Spragg¹,

Calkins²

2008

J.A.F.I.B

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Atrial fibrillation (AF) is a common tachyarrhythmia. There are over 2 million patients in the US with AF currently, 1 and as the median age of the population increases, the prevalence of AF likely will as well. Strategies for treating AF are diverse, and include options ranging from simple observation to pharmacotherapy to catheter-based and surgical interventions. Therapeutic approaches to AF historically have been divided into rate-control and rhythm-control categories, the former focusing on simply reducing ventricular response rates and the latter on restoration of sinus rhythm.Over the last 15 years, there has been an explosion of rhythmcontrol therapies, particularly in the field of catheter-based ablation. The proliferation of these ablative approaches has led to new insights into AF, both in terms of the mechanism(s) of the disease itself, and in the potential harm that patients can suffer during attempts at restoration of sinus rhythm. This review focuses on the complications, both the familiar and the newly appreciated, that may occur during catheter ablation of AF. Definition of Pericardial FatIn the late 1950s, Gordon Moe hypothesized that AF was the consequence of multiple, wandering reentrant waves coursing through atrial tissue.2,3 His hypothesis was confirmed by the work of Allessie and colleagues thirty years later, 4-6 when they demonstrated that sustained AF depended on functional reentry of multiple wavefronts through a critical mass of atrial tissue. At approximately the same time, Haisseguerre and colleagues demonstrated that initiation of AF was triggered by spontaneous ectopy originating from foci in the pulmonary veins(PV).7 Thus, the mechanisms of AF -functional reentry dependent on a critical mass of atrial tissue, triggered by ectopic beats within the PVs -were partially understood. Those mechanisms (triggers and substrate) constitute the primary targets for modern AF ablation. Other aspects of AF induction and perpetuation, including the role of ganglionic plexi and stable rotors, have also been proposed as important physiological modifiers of AF and as ablation targets. 8As the mechanisms underlying AF were determined, strategies to treat AF with catheter ablation evolved accordingly. Early ablative procedures focused on disrupting the critical mass of atrial tissue thought to be critical for perpetuation of AF. Linear lesion sets in the right atrium, left atrium, or both were delivered with the goal of interrupting reentrant circuits.9-12 These stra gies, though, were of limited efficacy at eliminating AF.

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Electrophysiologic mechanisms of perpetuation of atrial fibrillation

Cited by 178 publications

References 41 publications

Inducibility of atrial fibrillation during electrophysiologic evaluation is associated with increased dispersion of atrial refractoriness

Inducibility of atrial fibrillation during electrophysiologic evaluation is associated with increased dispersion of atrial refractoriness

Hypertension and paroxysmal atrial fibrillation: a novel predictive role of high sensitivity C-reactive protein in cardioversion and long-term recurrence

Catheter Ablation for AF: Past, Present, and Future

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