Left-to-Right Gradient of Atrial Frequencies During Acute Atrial Fibrillation in the Isolated Sheep Heart

Mansour, Moussa; Mandapati, Ravi; Berenfeld, Omer; Chen, Jay; Samie, Faramarz H.; Jalife, José

doi:10.1161/01.cir.103.21.2631

Cited by 341 publications

(332 citation statements)

References 39 publications

(46 reference statements)

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“…As persAF is a more complex arrhythmia than pAF, the identification of atrial areas for successful ablation in patients with persAF remains a challenge due to the co-existence of multiple arrhythmogenic mechanisms [4,35]. Previous works have shown that the DF measured from AEGs correlates with the local main activation wave during persAF [9, 14,36].…”

Section: Mechanisms For Persaf Maintenancementioning

confidence: 99%

An interactive platform to guide catheter ablation in human persistent atrial fibrillation using dominant frequency, organization and phase mapping

Salinet

Almeida

et al. 2017

Computer Methods and Programs in Biomedicine

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Section: Mechanisms For Persaf Maintenancementioning

confidence: 99%

An interactive platform to guide catheter ablation in human persistent atrial fibrillation using dominant frequency, organization and phase mapping

Salinet

Almeida

et al. 2017

Computer Methods and Programs in Biomedicine

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“…28 Similar LA to RA DF 28 gradients were reproduced in a subsequent study by the same group (see Figure 7). 29 Because the frequency of rotational activity was so high, only tissue in close proximity to the rotor could activate in a 1:1 fashion, and at distant sites the wavefronts underwent wavebrake and initiated chaotic and fibrillatory conduction. 29 Lazar et al extended the concept of DF mapping to humans and demonstrated LA to RA DF gradients in patients with paroxysmal AF, with the highest DFs at the junction between the pulmonary veins and the LA.…”

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

confidence: 99%

“…29 Because the frequency of rotational activity was so high, only tissue in close proximity to the rotor could activate in a 1:1 fashion, and at distant sites the wavefronts underwent wavebrake and initiated chaotic and fibrillatory conduction. 29 Lazar et al extended the concept of DF mapping to humans and demonstrated LA to RA DF gradients in patients with paroxysmal AF, with the highest DFs at the junction between the pulmonary veins and the LA. This gradient, however, was not present among patients with persistent AF, again suggesting a different mechanism for sustaining AF of longer duration.…”

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

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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...

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“…Recently, Mansour and colleagues, 9 using optical and electrical mapping techniques, have shown a gradient of frequencies between the left and right atria in the acetylcholine-mediated, pacing-induced model of sustained AF in isolated sheep hearts. In their experiments, the LA demonstrated organized electrical activity with the presence of a dominant frequency (DF), which was consistently higher than those in the recordings from the right atrium (RA).…”

mentioning

confidence: 99%

Presence of Left-to-Right Atrial Frequency Gradient in Paroxysmal but Not Persistent Atrial Fibrillation in Humans

et al. 2004

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Background— Recent studies have demonstrated spatiotemporal organization in atrial fibrillation (AF), with a left-to-right atrial frequency gradient during AF in isolated sheep hearts. We hypothesized that human AF would also manifest a left-to-right atrial frequency gradient. Methods and Results— Thirty-one patients aged 56.7±10.5 years with a history of paroxysmal or persistent (>1 month) AF were included. Recordings were made at each pulmonary vein (PV) ostium and simultaneously from the coronary sinus (CS) and posterior right atrium (RA) during AF. Sequential fast Fourier transforms (FFTs) were performed. FFT profiles were analyzed to determine the dominant frequency (DF). There were 18 patients with paroxysmal AF and 13 with persistent AF. In the paroxysmal group, there was a significant left-to-right atrial DF gradient, with DF highest at the PV/left atrial (LA) junction, intermediate at the CS, and lowest in the RA (6.2±0.8, 5.5±0.7, and 5.1±0.6 Hz, respectively; P <0.001). There were no patients in whom DF was greater at the RA than the PV/LA junction. In the persistent group, there was no significant difference between DF recorded from the LA/PV junction, CS, and RA (6.1±0.7, 5.8±0.6, and 5.8±0.6 Hz, respectively; P =NS). Conclusions— In humans with paroxysmal AF, DFs are highest at the PV/LA junction, intermediate in the CS, and slowest in the posterior RA. These findings agree with animal models that suggest that the posterior LA may play an important role in maintaining paroxysmal AF. The role of the posterior LA in persistent AF requires further study.

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Left-to-Right Gradient of Atrial Frequencies During Acute Atrial Fibrillation in the Isolated Sheep Heart

Cited by 341 publications

References 39 publications

An interactive platform to guide catheter ablation in human persistent atrial fibrillation using dominant frequency, organization and phase mapping

An interactive platform to guide catheter ablation in human persistent atrial fibrillation using dominant frequency, organization and phase mapping

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

Presence of Left-to-Right Atrial Frequency Gradient in Paroxysmal but Not Persistent Atrial Fibrillation in Humans

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