Residual Arrhythmogenic Foci Predict Recurrence in Long-Standing Persistent Atrial Fibrillation Patients After Sinus Rhythm Restoration Ablation

Kurotobi, Toshiya; Shimada, Yoshihisa; Kino, Naoto; Ito, Kenichi; Tonomura, Daisuke; Yano, Kentarô; Tanaka, Chiharu; Yoshida, Masahiro; Tsuchida, Takao; Fukumoto, Histohi

doi:10.1016/j.cjca.2014.10.013

Cited by 7 publications

(8 citation statements)

References 17 publications

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“…Focal sources have also been identified in many other studies. 4 , 7 , 30 New wavefronts due to endocardial-epicardial dissociation have been observed, although in contrast to the findings here, these were not in repeated locations. 8 There are some studies with new wavefronts occurring in repeated locations, including the study of Filgueiras-Rama et al 31 in which organized focal wavefronts were detected at the same site and with the same direction over four or more sequential beats.…”

Section: Discussioncontrasting

confidence: 99%

Determinants of new wavefront locations in cholinergic atrial fibrillation

Roney

Debney

et al. 2018

EP Europace

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AimsAtrial fibrillation (AF) wavefront dynamics are complex and difficult to interpret, contributing to uncertainty about the mechanisms that maintain AF. We aimed to investigate the interplay between rotors, wavelets, and focal sources during fibrillation.Methods and resultsArrhythmia wavefront dynamics were analysed for four optically mapped canine cholinergic AF preparations. A bilayer computer model was tuned to experimental preparations, and varied to have (i) fibrosis in both layers or the epicardium only, (ii) different spatial acetylcholine distributions, (iii) different intrinsic action potential duration between layers, and (iv) varied interlayer connectivity. Phase singularities (PSs) were identified and tracked over time to identify rotational drivers. New focal wavefronts were identified using phase contours. Phase singularity density and new wavefront locations were calculated during AF. There was a single dominant mechanism for sustaining AF in each of the preparations, either a rotational driver or repetitive new focal wavefronts. High-density PS sites existed preferentially around the pulmonary vein junctions. Three of the four preparations exhibited stable preferential sites of new wavefronts. Computational simulations predict that only a small number of connections are functionally important in sustaining AF, with new wavefront locations determined by the interplay between fibrosis distribution, acetylcholine concentration, and heterogeneity in repolarization within layers.ConclusionWe were able to identify preferential sites of new wavefront initiation and rotational activity, in order to determine the mechanisms sustaining AF. Electrical measurements should be interpreted differently according to whether they are endocardial or epicardial recordings.

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Section: Discussioncontrasting

confidence: 99%

Determinants of new wavefront locations in cholinergic atrial fibrillation

Roney

Debney

et al. 2018

EP Europace

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“…This evidence may explain the clue why a number of RF applications were needed to suppress the autonomic activated AF occurrences around the CS ostium. Our previous study supported the necessity to vigorously delineate the residual non-PV foci after an extensive PV isolation procedure in patients with long-standing AF 9 . Although the posteroseptal region around the CS ostium seems to be less important for the ablation of AF, further attention should be paid to that area to improve the outcome of AF ablation in some treatment-resistant types of long-standing AF.…”

Section: Discussionsupporting

confidence: 54%

Arrhythmogenic triggers associated with an autonomic response from a posteroseptal region after extensive ablation in a patient with long-standing atrial fibrillation

Kino

Kurotobi

Ito

et al. 2015

HeartRhythm Case Reports

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“…[69][70][71][72][73][74] Fortunately these sites can be revealed in patients with paroxysmal and persistent AF with the infusion of highdose isoproterenol. 9,11,75 …”

Section: Isoproterenolmentioning

confidence: 99%

“…[9][10][11][12] This article reviews the pathophysiological background and evidence for the use of pharmacological challenges during catheter ablation procedures.…”

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Pharmacological Tests in Atrial Fibrillation Ablation

Gourraud

Andrade

Macle

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia observed in clinical practice, occurring in approximately 2 % of the general population.1-3 A progressive increase in both the prevalence and incidence of AF has been demonstrated in recent years, defining AF as a major economic and public health issue. 1 The identification of sites of AF initiation and/or maintenance within the pulmonary veins (PVs) has led to the development of percutaneous procedures to electrically isolate the PVs from the left atrium (LA). 4 Large observational studies and multiple randomised-controlled trials have demonstrated that catheter ablation is universally superior to anti-arrhythmic drugs (AADs) for the maintenance of sinus rhythm (66-89 % versus 9-58 %, respectively) and results in a greater improvement in arrhythmia-related symptoms, exercise capacity and quality of life.1,2,5-8 As a result, catheter ablation has become the 'standard of care' for the maintenance of sinus rhythm in symptomatic patients in whom drugs are ineffective or poorly tolerated.While the results of ablation are unequivocally superior to medical therapy, they are unfortunately not flawless: approximately 30 % of paroxysmal AF patients will experience arrhythmia recurrence after a single ablation procedure.8 As most recurrences are in association with PV reconnection or as a result of non-PV triggers, several pharmacological challenges have been proposed to improve outcomes. [9][10][11][12] This article reviews the pathophysiological background and evidence for the use of pharmacological challenges during catheter ablation procedures. Pathophysiology of Atrial Fibrillation and Atrial Fibrillation Catheter AblationDespite decades of progress, there is no comprehensive pathophysiological explanation of AF. Early hypotheses postulated that AF resulted from the co-existence of multiple independent wavelets propagating randomly throughout the left and right atria (the 'multiple wavelet hypothesis'). 13,14 This hypothesis suggested that as long as the atria had a sufficient electrical mass, and an adequately short refractory period, AF could be initiated and indefinitely perpetuated. 15 Based on this theory, the early surgical interventions for AF were designed to reduce the excitable mass of atrial tissue by compartmentalising the atria into smaller regions incapable of sustaining a critical number of circulating wavelets. 16 Unfortunately this strategy has proved to be of limited efficacy and has been associated with a substantial risk of major complications. 17In the late 1990s, Haïssaguerre and colleagues demonstrated that AF is a triggered arrhythmia initiated by rapid repetitive discharges, predominantly from the proximal aspect of the PVs. 4 This discovery led to the development of percutaneous procedures to directly eliminate spontaneous focal ectopic activity within the PVs. However, early AF recurrences from the targeted and other nontargeted PVs led to modification of the ablation strategy to electrically isolate all of the PV...

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Residual Arrhythmogenic Foci Predict Recurrence in Long-Standing Persistent Atrial Fibrillation Patients After Sinus Rhythm Restoration Ablation

Cited by 7 publications

References 17 publications

Determinants of new wavefront locations in cholinergic atrial fibrillation

Determinants of new wavefront locations in cholinergic atrial fibrillation

Arrhythmogenic triggers associated with an autonomic response from a posteroseptal region after extensive ablation in a patient with long-standing atrial fibrillation

Pharmacological Tests in Atrial Fibrillation Ablation

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