Future Directions for Mapping Atrial Fibrillation

Abstract

Mapping for AF focuses on the identification of regions of interest that may guide management and – in particular – ablation therapy. Mapping may point to specific mechanisms associated with localised scar or fibrosis, or electrical features, such as localised repetitive, rotational or focal activation. In patients in whom AF is caused by disorganised waves with no spatial predilection, as proposed in the multiwavelet theory for AF, mapping would be of less benefit. The role of AF mapping is controversial at the current time in view of the debate over the underlying mechanisms. However, recent clinical expansions of mapping technologies confirm the importance of understanding the state of the art, including limitations of current approaches and potential areas of future development.

Review of Ex Vivo Cardiac Electrical Mapping and Intelligent Labeling of Atrial Fibrillation Substrates

“…(1) Localized source excitation [14][15] : During AF triggering, some areas of abnormal excitation radiate high-frequency pulses in all directions, whereas the surrounding tissues cannot produce 1:1 conduction with the driving lesion because of the anisotropy and inhomogeneity of the conduction, which leads to AF.…”

Computer Simulations of Composite Maps for Detection of Atrial Fibrillation Mechanisms

“…Many localized mechanisms have been described as possible perpetuators of AF episodes; such as, functional reentries (rotors), transmural breakthroughs or focal activity [1]. Regardless of the underlying mechanism, AF drivers are expected to entrain their vicinities and exhibit repetitive propagation that is observed through intracardiac recordings [2].…”