Instantaneous Amplitude and Frequency Modulations Detect the Footprint of Rotational Activity and Reveal Stable Driver Regions as Targets for Persistent Atrial Fibrillation Ablation

Quintanilla, Jorge G.; Alfonso-Almazán, José Manuel; Pérez‐Castellano, Nicasio; Pandit, Sandeep V.; Jalife, José; Pérez-Villacastín, Julián; Filgueiras-Rama, David

doi:10.1161/circresaha.119.314930

Cited by 28 publications

(51 citation statements)

References 34 publications

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“…The prevalence of non‐PV triggers is variable among different studies, although they can be documented in up to 60% of patients with AF 71 . Moreover, extra PV trigger locations may also participate in AF maintenance as areas for driver sources sustaining the overall arrhythmia outside the PVs 72–74 …”

Section: Anatomically Based Approaches Beyond the Pulmonary Veinsmentioning

confidence: 99%

“…The CS is widely recognized as a focal source of AF triggers 56 . Moreover, the CS may also host AF drivers sustaining fibrillation dynamics 72 . This role as a critical driver for AF maintenance may be explained by the fact that the CS is surrounded by a myocardial sleeve whose fiber direction abruptly changes with respect to the contiguous left atrial wall 95 .…”

Section: Anatomically Based Approaches Beyond the Pulmonary Veinsmentioning

confidence: 99%

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Anatomical targets and expected outcomes of catheter‐based ablation of atrial fibrillation in 2020

Rosa

Quintanilla

Salgado

et al. 2021

Pacing Clinical Electrophis

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Anatomical‐based approaches, targeting either pulmonary vein isolation (PVI) or additional extra PV regions, represent the most commonly used ablation treatments in symptomatic patients with atrial fibrillation (AF) recurrences despite antiarrhythmic drug therapy. PVI remains the main anatomical target during catheter‐based AF ablation, with the aid of new technological advances as contact force monitoring to increase safety and effective radiofrequency (RF) lesions. Nowadays, cryoballoon ablation has also achieved the same level of scientific evidence in patients with paroxysmal AF undergoing PVI. In parallel, electrical isolation of extra PV targets has progressively increased, which is associated with a steady increase in complex cases undergoing ablation. Several atrial regions as the left atrial posterior wall, the vein of Marshall, the left atrial appendage, or the coronary sinus have been described in different series as locations potentially involved in AF initiation and maintenance. Targeting these regions may be challenging using conventional point‐by‐point RF delivery, which has opened new opportunities for coadjuvant alternatives as balloon ablation or selective ethanol injection. Although more extensive ablation may increase intraprocedural AF termination and freedom from arrhythmias during the follow‐up, some of the targets to achieve such outcomes are not exempt of potential severe complications. Here, we review and discuss current anatomical approaches and the main ablation technologies to target atrial regions associated with AF initiation and maintenance.

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Section: Anatomically Based Approaches Beyond the Pulmonary Veinsmentioning

confidence: 99%

Section: Anatomically Based Approaches Beyond the Pulmonary Veinsmentioning

confidence: 99%

Anatomical targets and expected outcomes of catheter‐based ablation of atrial fibrillation in 2020

Rosa

Quintanilla

Salgado

et al. 2021

Pacing Clinical Electrophis

Self Cite

View full text Add to dashboard Cite

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“…Several studies in goats, sheep and pigs show that artificially maintained AF leads to increasingly longer episodes of sustained arrhythmia [9,[179][180][181]. As an example of the potential of these induced AF animal models, we have recently described transcriptomic and proteomic changes during different stages of the disease in sheep and shown that most significant changes occurred at early stages of disease progression [12].…”

Section: Animal Models Of Afmentioning

confidence: 99%

Functional genomics and epigenomics of atrial fibrillation

Victorino

Alvarez-Franco

Manzanares

2021

Journal of Molecular and Cellular Cardiology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…In human hearts with an abnormal heart rhythm, atrial fibrillation, the wave of an electrical impulse through the atrial muscle becomes disorganized in its sequence of activation. There has been mounting evidence that rotors, an action potential (AP) wave front (WF) in the shape of spiral, spins around its central core, and may be a sustaining mechanism of fibrillatory activity (3)(4)(5). Nearest its central core of a rotor, the single action potential wave front may spin at a fairly constant frequency within a rotation plane that is often parallel to the atrial tissue surface (6).…”

Section: Introductionmentioning

confidence: 99%

“…If the WF propagated centrifugally away from its core, then one might assume that the greatest increase in frequency shift would be detected by electrodes directly in front along the path of the core's movement. New ablation strategies are currently being formulated to target ablation at atrial regions with the highest dominant frequency of WFs (5). Yet, when rotors breached a perimeter of narrow spaced electrodes, the maximal frequency shifts (both highest and lowest simultaneously) occur at either side of the core's movement (2), not directly in front or behind of its path.…”

Section: Introductionmentioning

confidence: 99%

Diametric Property of Rotational and Spiral Doppler Effect in Human Heart Atrial Fibrillation

Rubenstein

2020

Preprint

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Compass mapping of moving rotors during atrial fibrillation unveiled unique properties of a different form of Doppler phenomenon. New rotational (RDE) and spiral Doppler effect (SDE) equations are derived and explain the diverging frequency changes (increasing and decreasing) that occur simultaneously on either side of passing rotor. These equations confirm that regions of maximal frequency are shifted 90 o compared to moving sources that exhibit classical doppler effects. The new SDE equation predicts sequence reversal, side-dependent frequency changes, and an unpaired strong-side wave front strike previously observed in patients with persistent atrial fibrillation. Conclusion: The diametric property of SDE is a mechanism behind dysynchrony of atrial fibrillation when a spinning source of wave fronts moves between two stationary electrodes. The diametric property of SDE in other fields of science are discussed. Statement of SignificanceSpinning sources of periodic wave fronts during atrial fibrillation do NOT exhibit classical Doppler effects when they approach and pass between 2 adjacent equidistant electrodes. The wave front is a spinning single spiral arm and frequency of wave front strikes is not only dependent upon distance between successive WF crests, but it is also dependent upon changes in rotation. Rotational and spiral math were developed and to derive new rotational and spiral wave front Doppler effect equations in two dimensions. These equations predict the unique and profound diametric property that have been observed clinically in which the strong side electrodes record an approaching increasing frequency while the weak side electrodes record an approaching decreasing frequency. The solution opens up many new avenues of research, not only into atrial fibrillation, but at all levels of nature, into objects that spin. equations are derived, identifying a special diametric property of frequency changes unique to the observation and recording of spinning bodies in motion. The WF frequency observed is relative to the side of the spin of the moving body. These findings may be at the crux of many other natural spinning or spiral phenomena not yet explained. A. Cardiac electrophysiologic waves -Rotor classificationA wave is the disturbance of a field or particles that results in an oscillation which propagates the energy over distances through a mass or medium without the transfer of mass itself (11). Waves are typically classified by what media that the waves propagate and in what 3-dimensional orientation that the oscillation occurs. Most commonly observed waves are either longitudinal or transverse, or a combination of the two. A recent addition to the classification of wave types is the rotational wave (12). This form of wave rotates around a central position that its wave peak appears to be chasing its own tail. Another visual description of a rotational wave is a transverse wave that propagates in a circle. Physical examples ranging micro to macro scales include circular polarized light to hurricane...

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Instantaneous Amplitude and Frequency Modulations Detect the Footprint of Rotational Activity and Reveal Stable Driver Regions as Targets for Persistent Atrial Fibrillation Ablation

Abstract: Supplemental Digital Content is available in the text.

Cited by 28 publications

References 34 publications

Anatomical targets and expected outcomes of catheter‐based ablation of atrial fibrillation in 2020

Anatomical targets and expected outcomes of catheter‐based ablation of atrial fibrillation in 2020

Functional genomics and epigenomics of atrial fibrillation

Diametric Property of Rotational and Spiral Doppler Effect in Human Heart Atrial Fibrillation

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