Epicardial Mapping of Chronic Atrial Fibrillation in Patients

Sahadevan, Jayakumar; Ryu, Kyungmoo; Peltz, L; Khrestian, Celeen M.; Stewart, Robert W.; Markowitz, Alan H.; Waldo, Albert L.

doi:10.1161/01.cir.0000147781.02738.13

Cited by 254 publications

(205 citation statements)

References 16 publications

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“…Since optical dye fluorescence techniques employed in animal studies cannot be used in humans due to concerns over toxicity, contact electrode arrays are the most common mapping modality 13,14 although non-invasive and non-contact techniques using the inverse solution have been developed. 40,41 Contact arrays have been used to determine the spatio-temporal organization during human AF.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Mapping wide fields of view in animal studies is achieved in isolated heart preparations, while human mapping has been achieved either using contact electrode plaques on regions of the heart accessible during open heart surgery or using relatively few electrodes at percutaneous electrophysiology study. 13,14 Despite these studies, however, the mechanisms of human AF remain highly controversial, 7,15 and AF therapy has not advanced significantly in several years. 11,16 Ideally, human AF would be mapped in situ during clinical electrophysiologic study to avoid open heart surgery while enabling direct therapy (ablation) based upon patientspecific mapping results.…”

Section: Introductionmentioning

confidence: 99%

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Theoretical considerations for mapping activation in human cardiac fibrillation

Rappel

Narayan²

2013

Chaos: An Interdisciplinary Journal of Nonlinear Science

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Defining mechanisms for cardiac fibrillation is challenging because, in contrast to other arrhythmias, fibrillation exhibits complex non-repeatability in spatiotemporal activation but paradoxically exhibits conserved spatial gradients in rate, dominant frequency, and electrical propagation. Unlike animal models, in which fibrillation can be mapped at high spatial and temporal resolution using optical dyes or arrays of contact electrodes, mapping of cardiac fibrillation in patients is constrained practically to lower resolutions or smaller fields-of-view. In many animal models, atrial fibrillation is maintained by localized electrical rotors and focal sources. However, until recently, few studies had revealed localized sources in human fibrillation, so that the impact of mapping constraints on the ability to identify rotors or focal sources in humans was not described. Here, we determine the minimum spatial and temporal resolutions theoretically required to detect rigidly rotating spiral waves and focal sources, then extend these requirements for spiral waves in computer simulations. Finally, we apply our results to clinical data acquired during human atrial fibrillation using a novel technique termed focal impulse and rotor mapping (FIRM). Our results provide theoretical justification and clinical demonstration that FIRM meets the spatio-temporal resolution requirements to reliably identify rotors and focal sources for human atrial fibrillation. Atrial fibrillation (AF) is the most common heart rhythm disorder (cardiac arrhythmia) in the United States that may cause substantial morbidity and mortality. However, the precise mechanisms causing AF are still not well understood, partly due to difficulties in reliably mapping electrical activity during the spatio-temporal variations of AF in patients. In this article, we determine the minimal spatial and temporal resolution required to accurately map in humans the electrical rotors and focal sources shown to sustain AF in various model systems. We first test these requirements in computer simulations. We then validate that a recently developed mapping technique which employs bi-atrial multielectrode contact arrays is able to capture localized rotors and focal sources for human AF.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Theoretical considerations for mapping activation in human cardiac fibrillation

Rappel

Narayan²

2013

Chaos: An Interdisciplinary Journal of Nonlinear Science

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“…In another study, 9 patients with chronic AF the atrial electrogram showed an area of regular, rapid rhythm, consistent with the possibility that a driver causing fibrillatory conduction is one mechanism of AF in these patients. 36 Finally, in the study of Atienza et al, 33 ADO infusion in persistent AF patients increased local DFs only in the high RA, without significant changes at other atrial sites. Those data suggested that persistent AF also is maintained by high-frequency reentrant sources.…”

Section: Are There Rotors In the Human Atrium?mentioning

confidence: 93%

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

Vaquero¹,

Calvo²,

Jalife³

2008

Heart Rhythm

158

134

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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.

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“…Mechanizmem tej ogniskowej aktywności może być zarówno aktywność wyzwalana, jak i ogniskowo występujące zjawisko re-entry [109,110]. Hierarchiczną organizację AF z szybką aktywacją obszarów napędzających arytmię udokumentowano u pacjentów z napadowym AF [111,112], ale jest mniej oczywista u nieselekcjonowanych pacjentów z przetrwałym AF [113].…”

Section: Ogniskowa Inicjacja I Podtrzymywanie Migotania Przedsionkówunclassified