Prevalence and mechanism of rotor activation identified during atrial fibrillation by noncontact mapping: Lack of evidence for a role in the maintenance of atrial fibrillation

Yamabe, Hiroshige; Kanazawa, Hisanori; Ito, Miwa; Kaneko, Shozo; Ogawa, Hisao

doi:10.1016/j.hrthm.2016.07.030

Cited by 22 publications

(14 citation statements)

References 26 publications

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“…Narayan et al proposed that focal impulses and localized rotational activation (rotors) functioned as maintainers of AF 5 . However, others have observed multiple wavefronts being the most common activation pattern seen during either noninvasive body surface mapping or contact epicardial mapping of AF, and therefore reasoned that rotors might not play such a critical role 6‐8 …”

Section: Introductionmentioning

confidence: 99%

Diverse activation patterns during persistent atrial fibrillation by noncontact charge‐density mapping of human atrium

Shi

Chen

Butcher

et al. 2020

Journal of Arrhythmia

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Background Global simultaneous recording of atrial activation during atrial fibrillation (AF) can elucidate underlying mechanisms contributing to AF maintenance. A better understanding of these mechanisms may allow for an individualized ablation strategy to treat persistent AF. The study aims to characterize left atrial endocardial activation patterns during AF using noncontact charge‐density mapping. Methods Twenty‐five patients with persistent AF were studied. Activation patterns were characterized into three subtypes: (i) focal with centrifugal activation (FCA); (ii) localized rotational activation (LRA); and (iii) localized irregular activation (LIA). Continuous activation patterns were analyzed and distributed in 18 defined regions in the left atrium. Results A total of 144 AF segments with 1068 activation patterns were analyzed. The most common pattern during AF was LIA (63%) which consists of four disparate features of activation: slow conduction (45%), pivoting (30%), collision (16%), and acceleration (7%). LRA was the second‐most common pattern (20%). FCA accounted for 17% of all activations, arising frequently from the pulmonary veins (PVs)/ostia. A majority of patients (24/25; 96%) showed continuous and highly dynamic patterns of activation comprising multiple combinations of FCA, LRA, and LIA, transitioning from one to the other without a discernible order. Preferential conduction areas were typically seen in the mid‐anterior (48%) and lower‐posterior (40%) walls. Conclusion Atrial fibrillation is characterized by heterogeneous activation patterns identified in PV‐ostia and non‐PV regions throughout the LA at varying locations between individuals. Clinical implications of individualized ablation strategies guided by charge‐density mapping need to be determined.

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Section: Introductionmentioning

confidence: 99%

Diverse activation patterns during persistent atrial fibrillation by noncontact charge‐density mapping of human atrium

Shi

Chen

Butcher

et al. 2020

Journal of Arrhythmia

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“…Focal activations during AF are observed by practically all groups (short-lived, sustained, or both), and these activations can be real focal source(s) or breakthrough(s) from any remote sources (reentry or focal). 80 – 85 , 87 , 89 , 95 – 97 It was long ago postulated that AF can be maintained by focal sources, 98 , 99 and there has been an increasing amount data supporting this hypothesis, particularly during the past 10 years. 76 , 79 , 80 , 82 , 83 , 90 , 97 , 100 Interestingly, although the data from 1960 to 2000 almost universally supported reentry as the only mechanism of AF maintenance, 65 – 67 starting from about the beginning of the 21st century, an increasing number of studies have not or rarely observed reentry 77 , 78 , 81 and/or have consistently detected focal activations as either predominant or the only mechanism of AF maintenance.…”

Section: Electrophysiological Mechanisms Of Af: Reentry or Focal?mentioning

confidence: 99%

Investigational Anti–Atrial Fibrillation Pharmacology and Mechanisms by Which Antiarrhythmics Terminate the Arrhythmia: Where Are We in 2020?

Burashnikov

2020

Journal of Cardiovascular Pharmacology

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: Antiarrhythmic drugs remain the mainstay therapy for patients with atrial fibrillation (AF). A major disadvantage of the currently available anti-AF agents is the risk of induction of ventricular proarrhythmias. Aiming to reduce this risk, several atrial-specific or -selective ion channel block approaches have been introduced for AF suppression, but only the atrial-selective inhibition of the sodium channel has been demonstrated to be valid in both experimental and clinical studies. Among the other pharmacological anti-AF approaches, “upstream therapy” has been prominent but largely disappointing, and pulmonary delivery of anti-AF drugs seems to be promising. Major contradictions exist in the literature about the electrophysiological mechanisms of AF (ie, reentry or focal?) and the mechanisms by which anti-AF drugs terminate AF, making the search for novel anti-AF approaches largely empirical. Drug-induced termination of AF may or may not be associated with prolongation of the atrial effective refractory period. Anti-AF drug research has been largely based on the “suppress reentry” ideology; however, results of the AF mapping studies increasingly indicate that nonreentrant mechanism(s) plays an important role in the maintenance of AF. Also, the analysis of anti-AF drug-induced electrophysiological alterations during AF, conducted in the current study, leans toward the focal source as the prime mechanism of AF maintenance. More effort should be placed on the investigation of pharmacological suppression of the focal mechanisms.

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“…First descriptions of rotational activations were from studies that undertook sequential mapping with multi-polar spiral catheter (Atienza et al, 2011 ; Ghoraani et al, 2013 ) The Focal Impulse and Rotor Modulation (FIRM) guided technique was the first panoramic mapping study that showed high success rates with ablating AF drivers (Narayan et al, 2012 ). Other panoramic mapping techniques included body surface potentials mapping with inverse-solution electrocardiographic imaging (ECGI) (Haissaguerre et al, 2014 ) mapping of wavefront propagation using intracardiac multipolar catheter (CARTOFINDER) (Honarbakhsh et al, 2018 ) and non-contact mapping using a multielectrode array catheter (ENSITE) (Yamabe et al, 2016 ; Lee et al, 2017 ). Table 1 summarizes the different panoramic mapping techniques utilized toward detection of AF rotors and foci.…”

Section: Introductionmentioning

confidence: 99%

“…Several groups have used the Ensite multi-electrode array catheter (St Jude Medical, MN, USA) for panoramic non-contact AF mapping (Yamabe et al, 2016 ; Lee et al, 2017 ). This is a commercially available system that affords recording of unipolar virtual electrograms that can be superimposed onto the 3-D endocardial geometry to display wavefront propagation as animated isopotential color map.…”

Section: Introductionmentioning

confidence: 99%

“…This is a commercially available system that affords recording of unipolar virtual electrograms that can be superimposed onto the 3-D endocardial geometry to display wavefront propagation as animated isopotential color map. Using this technique, transient AF rotors were seen in 1 out of 15 persistent AF and 10 out of 60 paroxysmal AF patients that lasted for a mean of 6.1 s in one study (Yamabe et al, 2016 ). In another study, the Ensite non-contact mapping system failed to identify any focal sources in 15 persistent AF patients (Lee et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

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Targeting the Substrate in Ablation of Persistent Atrial Fibrillation: Recent Lessons and Future Directions

2018

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While isolation of the pulmonary veins is firmly established as effective treatment for the majority of paroxysmal atrial fibrillation (AF) patients, there is recognition that patients with persistent AF have substrate for perpetuation of arrhythmia existing outside of the pulmonary veins. Various computational approaches have been used to identify targets for effective ablation of persistent AF. This paper aims to discuss the clinical aspects of computational approaches that aim to identify critical sites for treatment. Various analyses of electrogram characteristics have been performed with this aim. Leading techniques for electrogram analysis are Complex Fractionated Atrial Electrograms (CFAE) and Dominant Frequency (DF). These techniques have been the subject of clinical trials of which the results are discussed. Evaluation of the activation patterns of atria in AF has been another avenue of research. Focal Impulse and Rotor Modulation (FIRM) mapping and forms of Body Surface Mapping aim to characterize multiple atrial wavelets, macro-reentry and focal sources which have been proposed as basic mechanisms perpetuating AF. Both invasive and non-invasive activation mapping techniques are reviewed. The presence of atrial fibrosis causes non-uniform anisotropic impulse propagation. Therefore, identification of fibrosis by imaging techniques is an avenue of potential research. The leading contender for imaging-based techniques is Cardiac Magnetic Resonance (CMR). As this technology advances, improvements in resolution and scar identification have positioned CMR as the mode of choice for analysis of atrial structure. AF has been demonstrated to be associated with obesity, inactivity and diseases of modern life. An opportunity exists for detailed computational analysis of the impact of risk factor modification on atrial substrate. This ranges from microstructural investigation through to examination at a population level via registries and public health interventions. Computational analysis of atrial substrate has moved from basic science toward clinical application. Future directions and potential limitations of such analyses are examined in this review.

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Prevalence and mechanism of rotor activation identified during atrial fibrillation by noncontact mapping: Lack of evidence for a role in the maintenance of atrial fibrillation

Cited by 22 publications

References 26 publications

Diverse activation patterns during persistent atrial fibrillation by noncontact charge‐density mapping of human atrium

Diverse activation patterns during persistent atrial fibrillation by noncontact charge‐density mapping of human atrium

Investigational Anti–Atrial Fibrillation Pharmacology and Mechanisms by Which Antiarrhythmics Terminate the Arrhythmia: Where Are We in 2020?

Targeting the Substrate in Ablation of Persistent Atrial Fibrillation: Recent Lessons and Future Directions

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