Spatiotemporal organization during ablation of persistent atrial fibrillation

Iravanian, Shahriar; Langberg, Jonathan J.

doi:10.1016/j.hrthm.2015.04.027

Cited by 9 publications

(10 citation statements)

References 30 publications

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“…Interpretation of the time course of organization depends on the model of AF mechanisms, that fall into two camps. The prolonged timecourse of organization concurs with recent studies (17) that showed a stepwise organization consistent with localized rotors.…”

Section: Discussionsupporting

confidence: 91%

Electrocardiographic spatial loops indicate organization of atrial fibrillation minutes before ablation-related transitions to atrial tachycardia

Baykaner

Trikha

Zaman

et al. 2017

Journal of Electrocardiology

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Background During ablation for atrial fibrillation (AF), it is challenging to anticipate transitions to organized tachycardia (AT). Defining indices of this transition may help to understand fibrillatory conduction and help track therapy. Objective To determine the timescale over which atrial fibrillation (AF) organizes en route to atrial tachycardia (AT) using the ECG referenced to intracardiac electrograms. Methods In 17 AF patients at ablation (58.7±9.6 years; 53% persistent AF) we analyzed spatial loops of atrial activity on the ECG and intracardiac electrograms over successive timepoints. Loops were tracked at precisely 15, 10, 5, 3 and 1 minute prior to defined transitions of AF to AT. Results Organizational indices reliably quantified changes from AF to AT. Spatiotemporal AF organization on the ECG was identifiable at least 15 minutes before AT was established (p=0.02). Conclusions AF shows anticipatory global organization on the ECG minutes before AT is clinically evident. These results offer a foundation to establish when AF therapy is on an effective path, and for a quantitative classification separating AT from AF.

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Section: Discussionsupporting

confidence: 91%

Electrocardiographic spatial loops indicate organization of atrial fibrillation minutes before ablation-related transitions to atrial tachycardia

Baykaner

Trikha

Zaman

et al. 2017

Journal of Electrocardiology

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“…Previously, we have described sudden transitions from AF to a regular flutter. 12,13 A detailed analysis of these transitions is useful in revealing the underlying dynamics. Figure 8A shows such a transition in a multi-zone AF.…”

Section: Transitions From Af To Fluttermentioning

confidence: 99%

“…11 Previously, we analyzed the intracardiac recordings during ablation of persistent AF using both time and frequency domain analysis methods to gain mechanistic insight into AF. 12,13 We showed that temporally-dense and high-resolution frequency domain analysis is a valuable tool in elucidating the spatiotemporal dynamics of AF. Our main finding was that transitions from irregular and chaotic AF to regular flutter occur suddenly and have the hallmarks of phase transitions in complex dynamical systems.…”

Section: Introductionmentioning

confidence: 99%

Heterogeneity of the Frequency Domain Patterns in Persistent Atrial Fibrillation

Iravanian

Langberg

2018

Preprint

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1 5 10 15 20 Iravanian, Langberg. Frequency Domain Patterns in Atrial Fibrillation. Abstract Background:Persistent atrial fibrillation (AF) has remained a challenging clinical problem. The mechanisms of persistent AF are still subject to debate. Both a single mother-rotor with fibrillatory conduction and multiple meandering spiral waves have been proposed to explain persistent AF. Previous frequency domain studies have reported the presence of dominant frequency (DF) gradient (a marker of single mother-rotor) in paroxysmal, but not persistent AF. Methods and Results:We performed temporally-dense high-resolution frequency domain analysis of 10-40 minutes segments of intracardiac signals recorded in 24 patients undergoing ablation of persistent AF. We observed two predominant patterns. The expected signature of the mother-rotor mechanism was observed in 38% of the patients. The frequency pattern in 54% consisted of two or more distinct frequency peaks with no obvious gradient, which is consistent with multiple separate primary spiral waves in electrophysiologically heterogeneous areas of atria. The average measured number of rotors per case was 1.71 ± 0.32, which provides a lower limit on the actual number of rotors. The single-zone pattern was exclusively seen in patients who were on a membrane-active antiarrhythmic medication at the time of ablation (P < 0.005). Conclusions:AF is a heterogeneous disorder. High-frequency resolution analysis is a useful tool to detect the underlying mechanisms of AF and to classify it into patterns consistent with a single mother-rotor vs. multiple meandering wavelets.

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“…Further clinical evidence comes from stable gradients in AF dominant frequency (Martins et al, 2014), activation vectors (Gerstenfeld, Sahakian, & Swiryn, 1992) and termination of persistent AF by focal ablation (S. . A recent paper describing a stochastic spatiotemporal organization with ablation provides indirect proof (Iravanian & Langberg, 2015) as do electrogram recurrence patterns (Ng, Gordon, Passman, et al, 2014). Even the success of the Cox-maze procedure may concord with rotors as compartmentalization reduces the 'elbow-room' of a rotor thus increasing likeliness it will encounter a barrier and terminate re-entry (Carrick et al, 2013).…”

Section: Sustaining Mechanisms In Afmentioning

confidence: 99%

The contact electrogram and its architectural determinants in atrial fibrillation

Zaman¹,

Al-Aidarous²,

Patel³

et al. 2013

The Lancet

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Spatiotemporal organization during ablation of persistent atrial fibrillation

Cited by 9 publications

References 30 publications

Electrocardiographic spatial loops indicate organization of atrial fibrillation minutes before ablation-related transitions to atrial tachycardia

Electrocardiographic spatial loops indicate organization of atrial fibrillation minutes before ablation-related transitions to atrial tachycardia

Heterogeneity of the Frequency Domain Patterns in Persistent Atrial Fibrillation

The contact electrogram and its architectural determinants in atrial fibrillation

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