Rotors of truly atypical atrial flutters visualized by FIRM mapping and 3D-MRI overlay on live fluoroscopy

Orlov, Michael V.; Горев, М. В.; Griben, Andre

doi:10.1007/s10840-013-9828-0

Cited by 5 publications

(2 citation statements)

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“…and Sir Thomas Lewis, then shown in animal models showing spiral waves (rotors) . There are now several reports on the FIRM of rotors and focal sources, and other groups have shown evidence for human AF rotors using other techniques …”

Section: Discussionmentioning

confidence: 99%

Stability of Rotors and Focal Sources for Human Atrial Fibrillation: Focal Impulse and Rotor Mapping (FIRM) of AF Sources and Fibrillatory Conduction

Swarup

Baykaner

Rostamian

et al. 2014

Cardiovasc electrophysiol

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Rotors and focal sources for human AF mapped by FIRM over prolonged time periods precess ("wobble") but remain within stable regions for thousands of cycles. Conversely, emanating activity such as spiral waves disorganize and collide with the fibrillatory milieu, explaining difficulties in using activation mapping or signal processing analyses at fixed electrodes to detect AF rotors. These results provide a rationale for targeted ablation at AF sources rather than fibrillatory spiral waves.

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Section: Discussionmentioning

confidence: 99%

Stability of Rotors and Focal Sources for Human Atrial Fibrillation: Focal Impulse and Rotor Mapping (FIRM) of AF Sources and Fibrillatory Conduction

Swarup

Baykaner

Rostamian

et al. 2014

Cardiovasc electrophysiol

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“…Recently, evidence for the presence and importance of rotors and focal sources in AF has been published by other groups using FIRM [94, 95] and alternative methods. In a recent clinical trial, an array of 252 body surface electrodes was used to map atrial activation during AF [96•].…”

Section: Af Maintenancementioning

confidence: 99%

Mechanisms Underlying AF: Triggers, Rotors, Other?

Krummen

Hebsur

Salcedo

et al. 2015

Curr Treat Options Cardio Med

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Opinion statement There is ongoing debate regarding the precise mechanisms underlying atrial fibrillation (AF). An improved understanding of these mechanisms is urgently needed to improve interventional strategies to suppress and eliminate AF, since the success of current strategies is suboptimal. At present, guidelines for AF ablation focus on pulmonary vein (PV) isolation for the prevention of arrhythmia. Additional targets are presently unclear, and include additional linear ablation and electrogram-guided substrate modification, without clear mechanistic relevance. PV and non-PV triggers are likely central in the first few seconds of AF initiation. Rapid activation from such triggers interacts with transitional mechanisms including conduction velocity slowing, action potential duration (APD) alternans, and steep APD restitution to cause conduction block and initiate functional reentry. However, complete suppression of potential triggers has proven elusive, and the intra-procedural mapping and targeting of transitional mechanisms has not been reported. A growing body of research implicates electrical rotors and focal sources as central mechanisms for the maintenance of AF. In several recent series, they were observed in nearly all patients with sustained arrhythmia. Ablation of rotor and focal source sites, prior to pulmonary vein isolation, substantially modulated atrial fibrillation in a high proportion of patients, and improved ablation outcomes versus pulmonary vein isolation alone. These results have subsequently been confirmed in multicenter series, and the improved outcomes have been found to persist to a mean follow-up of 3 years. Recently, rotors have been observed by multiple groups using diverse technologies. These findings represent a paradigm shift in AF, focusing on sustaining mechanisms, as is currently done with other arrhythmias such as atrioventricular node reentrant tachycardia. Studies are currently underway to assess the optimal strategy for the application of rotor-based ablation in AF management, including clinical trials on the relative efficacy of rotor-only ablation versus PVI-only ablation, which will inform future practice guidelines.

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CT in the Management of Cardiac Arrhythmias

Wilson¹,

Saremi

Narula

et al. 2017

Atlas of Cardiovascular Computed Tomography

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Rotors of truly atypical atrial flutters visualized by FIRM mapping and 3D-MRI overlay on live fluoroscopy

Abstract: Rotors of two different left atrial flutters were mapped using focal impulse and rotor modulation and 3D-MRI overlayed on live fluoroscopy and were successfully ablated in a patient with two prior left-atrium ablation procedures for recurrent atrial fibrillation.

Cited by 5 publications

References 0 publications

Stability of Rotors and Focal Sources for Human Atrial Fibrillation: Focal Impulse and Rotor Mapping (FIRM) of AF Sources and Fibrillatory Conduction

Stability of Rotors and Focal Sources for Human Atrial Fibrillation: Focal Impulse and Rotor Mapping (FIRM) of AF Sources and Fibrillatory Conduction

Mechanisms Underlying AF: Triggers, Rotors, Other?

CT in the Management of Cardiac Arrhythmias

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