Simultaneous epicardial and endocardial activation sequence mapping in the isolated canine right atrium.

Schuessler, Richard B.; Kawamoto, Tomoaki; Hand, Dwight; Mitsuno, Masataka; Bromberg, Burt I.; Cox, James L.; Boineau, John P.

doi:10.1161/01.cir.88.1.250

Cited by 189 publications

(96 citation statements)

References 23 publications

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“…AF is often described as a disorganized phenomenon, [3][4][5][6][7][8] but recently many features that suggest an underlying order have been reported. 9-11 Slocum et al showed that the power spectrum of AF had a discrete peak in the 4-9 Hz band, 15 and Gerstenfeld et al demonstrated preferential routes of wave propagation during AF by showing transient linking of atrial excitation.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Termination of Vagally Induced Canine Atrial Fibrillation by Mutual Information

Shimizu¹,

Osaka

Saitoh³

et al. 2001

Jpn Circ J

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Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Termination of Vagally Induced Canine Atrial Fibrillation by Mutual Information

Shimizu¹,

Osaka

Saitoh³

et al. 2001

Jpn Circ J

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“…24 A single relatively stable source in canine RA using a high concentration of acetylcholine by Schuessler et al, 8 and multifocal AF in the sterile pericarditis model by Waldo and colleagues, 6,25 as well, have been reported. Jalife and colleagues 4,26 used phase-based optical signal processing to demonstrate rotor activities with a spectrum of scenarios from single meandering rotor to multiple, periodic rotors giving rise to fibrillatory activation.…”

Section: Progressive Remodeling Of Atrial Tissue With Af Continuationmentioning

confidence: 99%

“…Localized drivers are difficult to detect in persistent AF with conventional techniques because of sequential temporospatial mapping, lack of specificity of complex atrial electrograms, intermittent firing, and spatial meandering. [7][8][9] Wide-field mapping tools have been used to capture these sources with the use of balloon, multispline probes 5,[10][11][12][13][14] or electrode arrays enveloping the torso. [15][16][17][18] Recent developments have allowed biatrial AF mapping using activation or phase-based analysis of body surface potentials.…”

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confidence: 99%

Driver Domains in Persistent Atrial Fibrillation

et al. 2014

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Background-Specific noninvasive signal processing was applied to identify drivers in distinct categories of persistent atrial fibrillation (AF). Methods and Results-In 103 consecutive patients with persistent AF, accurate biatrial geometry relative to an array of 252 body surface electrodes was obtained from a noncontrast computed tomography scan. The reconstructed unipolar AF electrograms acquired at bedside from multiple windows (duration, 9±1 s) were signal processed to identify the drivers (focal or reentrant activity) and their cumulative density map. The driver domains were catheter ablated by using AF termination as the procedural end point in comparison with the stepwise-ablation control group. The maps showed incessantly changing beat-to-beat wave fronts and varying spatiotemporal behavior of driver activities. Reentries were not sustained (median, 2.6 rotations lasting 449±89 ms), meandered substantially but recurred repetitively in the same region.In total, 4720 drivers were identified in 103 patients: 3802 (80.5%) reentries and 918 (19.5%) focal breakthroughs; most of them colocalized. Of these, 69% reentries and 71% foci were in the left atrium. Driver ablation alone terminated 75% and 15% of persistent and long-lasting AF, respectively. The number of targeted driver regions increased with the duration of continuous AF: 2 in patients presenting in sinus rhythm, 3 in AF lasting 1 to 3 months, 4 in AF lasting 4 to 6 months, and 6 in AF lasting longer. The termination rate sharply declined after 6 months. The mean radiofrequency delivery to AF termination was 28±17 minutes versus 65±33 minutes in the control group (P<0.0001). At 12 months, 85% patients with AF termination were free from AF, similar to the control population (87%,); P=not significant. Conclusions-Persistent Methods Study PopulationThis is a hospital-based study of patients with persistent AF. All consecutive patients referred for ablation of persistent AF were enrolled between May 2012 and June 2013. Persistent AF was defined as continuous AF from 7 days to 12 months and long-lasting AF beyond 12 months. There were no exclusion criteria based on the left atrial size, ventricular ejection fraction, or structural heart disease. All patients gave written informed consent to participate in the study, which involved the use of an investigational system for mapping. The study protocol was approved by the institutional Clinical Research and Ethics Committee. Noninvasive MappingIf patients presented in ongoing AF, mapping was performed bedside, within 24 hours preceding the invasive procedure. For those presenting in sinus rhythm, AF was induced in the electrophysiological laboratory by rapid atrial pacing decrementing up to 200-ms cycle length at the beginning of the invasive procedure and before transseptal puncture. Induced AF was analyzed after >30 minutes of sustenance (during this time, intracardiac catheter placement and invasive mapping were undertaken). Isoproterenol was not used to facilitate induction.The noninvasive mapping techniq...

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“…2,[5][6][7][8][9][10][11][12] Electric dissociation between the endocardial bundle network and the epicardial layer (EED) during AF is a prerequisite condition for transmural conduction of fibrillation waves because only in the presence of EED electric activity in 1 layer of the atrial wall can encounter excitable tissue in the opposing layer.We recently demonstrated that in goats EED increases during the first 6 months of AF, 13 which might well explain the higher incidence of breakthrough in complex substrates for AF. However, increasing evidence for altered intracellular Ca 2+ handling in atrial myocytes of AF patients supports the hypothesis that ectopic focal discharges because of triggered activity might also occur during AF and contribute to its perpetuation.…”

mentioning

confidence: 99%

Transmural Conduction Is the Predominant Mechanism of Breakthrough During Atrial Fibrillation

Eckstein

Zeemering

Linz

et al. 2013

Circ: Arrhythmia and Electrophysiology

139

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Present hypotheses on mechanisms underlying breakthrough events include transmural conduction from the opposing layer of the atrial wall (endo-epicardial or vice versa), transmural microreentry, or ectopic focal discharges. 2,[5][6][7][8][9][10][11][12] Electric dissociation between the endocardial bundle network and the epicardial layer (EED) during AF is a prerequisite condition for transmural conduction of fibrillation waves because only in the presence of EED electric activity in 1 layer of the atrial wall can encounter excitable tissue in the opposing layer.We recently demonstrated that in goats EED increases during the first 6 months of AF, 13 which might well explain the higher incidence of breakthrough in complex substrates for AF. However, increasing evidence for altered intracellular Ca 2+ handling in atrial myocytes of AF patients supports the hypothesis that ectopic focal discharges because of triggered activity might also occur during AF and contribute to its perpetuation. 9,12,14 © 2013 American Heart Association, Inc. Background-Endo-epicardial dissociation (EED) of electric activations resulting in transmural conduction of fibrillation waves (breakthroughs) has been postulated to contribute to the complexity of the substrate of atrial fibrillation (AF). The aim of this study was to elucidate the correlation between EED and incidence of breakthrough and to test the plausibility of transmural conduction versus ectopic focal discharges as sources of breakthrough. Methods and Results-We analyzed high-resolution simultaneous endo-epicardial in vivo mapping data recorded in left atrial free walls of goats with acute AF, 3 weeks and 6 months of AF (all n=7). Waves were analyzed for number, size, and width and categorized according to their origin outside (peripheral wave) or within the mapping area (breakthrough). Breakthrough incidence was lowest (2.1±1.0%) in acute AF, higher (11.4±6.1%) after 3 weeks (P<0.01 versus acute AF) and highest (14.2±3.8%) after 6 months AF (P<0.001 versus acute AF) and similar in the epicardium and endocardium. Most of the breakthroughs (86%; n=564) could be explained by transmural conduction, whereas only 13% (n=85) could be explained by ectopic focal discharges. Transmural microreentry did not play a role as source of breakthrough. Conclusions-This is the first study to present simultaneous endo-epicardial in vivo mapping data at sites of breakthrough events. Breakthrough incidence and degree of EED increased with increasing AF substrate complexity. In goat left atrial free walls, most of the breakthroughs can be explained by transmural conduction, whereas ectopic focal discharges play a limited role as source of breakthrough. (Circ Arrhythm Electrophysiol. 2013;6:334-341.) Circ Arrhythm Electrophysiol

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Simultaneous epicardial and endocardial activation sequence mapping in the isolated canine right atrium.

Cited by 189 publications

References 23 publications

Quantitative Analysis of Termination of Vagally Induced Canine Atrial Fibrillation by Mutual Information

Quantitative Analysis of Termination of Vagally Induced Canine Atrial Fibrillation by Mutual Information

Driver Domains in Persistent Atrial Fibrillation

Transmural Conduction Is the Predominant Mechanism of Breakthrough During Atrial Fibrillation

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