Structural remodeling and conduction velocity dynamics in the human left atrium: Relationship with reentrant mechanisms sustaining atrial fibrillation

Honarbakhsh, Shohreh; Schilling, Richard J.; Orini, Michele; Providência, Rui; Keating, Emily; Finlay, Malcolm; Sporton, Simon; Chow, Anthony W.; Earley, Mark J.; Lambiase, Pier D.; Hunter, Ross J.

doi:10.1016/j.hrthm.2018.07.019

Cited by 54 publications

(38 citation statements)

References 28 publications

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“…This study has shown that ESA were predominantly mapped to LVZs and that the proportion of LVZs strongly correlated to the number of ESA identified. These findings are supported by sites of structural remodeling resulting in alteration in CV dynamics that promote reentrant mechanisms 26,27 and that reentrant activity anchors to sites of structural heterogeneity 28 . The bipolar voltage map can thereby be used by the operator to plan the extent of their ablation.…”

Section: Discussionmentioning

confidence: 83%

Drivers in AF colocate to sites of electrogram organization and rapidity: Potential synergy between spectral analysis and STAR mapping approaches in prioritizing drivers for ablation

Honarbakhsh

Schilling

Keating

et al. 2020

Cardiovasc electrophysiol

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Introduction: Stochastic trajectory analysis of ranked signals (STAR) mapping has recently been used to ablate persistent atrial fibrillation (AF) with high rates of AF termination and long-term freedom from AF in small, single-arm studies. We hypothesized that rapidity and organization markers would correlate with early sites of activation (ESA). Methods:Patients undergoing persistent AF ablation as part of the STAR mapping study were included. Five-minute unipolar basket recordings used to create STAR maps were used to determine the minimum-cycle length (Min-CL) and CL variability (CLV) at each electrode to identify the site of the fastest Min-CL and lowest CLV across the left atrium (LA). The location of ESA targeted with ablation was compared with these sites. Dominant frequency was assessed at ESA and compared with that of neighboring electrodes to assess for regional gradients.Results: Thirty-two patients were included with 83 ESA ablated, with an ablation response at 73 sites (24 AF termination and 49 CL slowing ≥30 ms). Out of these, 54 (74.0%) and 56 (76.7%) colocated to sites of fastest Min-CL and lowest CLV, respectively. Regional CL and frequency gradients were demonstrable at majority of ESA. ESA colocating to sites of fastest Min-CL and lowest CLV were more likely to terminate AF with ablation (odds ratio, 34 and 29, respectively, P = .02). These showed a moderate sensitivity (74.0% Min-CL and 75.3% CLV) and specificity (66.7% Min-CL and 76.9% CLV) in predicting ESA with an ablation response.Conclusions: ESA correlate with rapidity and organization markers. Further work is needed to clarify any role for spectral analysis in prioritizing driver ablation. K E Y W O R D S atrial fibrillation, catheter ablation, cycle length, localized drivers, spectral analysis ---This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 83%

Drivers in AF colocate to sites of electrogram organization and rapidity: Potential synergy between spectral analysis and STAR mapping approaches in prioritizing drivers for ablation

Honarbakhsh

Schilling

Keating

et al. 2020

Cardiovasc electrophysiol

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“…It has been established that CV varies in areas of non‐low voltage zones (LVZs) compared to LVZs. It has also been shown that CV has a negative correlation between bipolar voltage and proportion of non‐LVZs . CVs of 1.59 and 0.98 m/s were used depending on the proportion of non‐LVZs and LVZs that was present, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…It has also been shown that CV has a negative correlation between bipolar voltage and proportion of non-LVZs. 7,8 CVs of 1.59 and 0.98 m/s 7,8 were used depending on the proportion of non-LVZs and LVZs that was present, respectively. In vitro study HL1 cells which are immortal murine cardiac atrial cell lines (Sigma-Aldrich Inc, NM) were used for the in vitro study.…”

Section: Activation Times and Pole Leadersmentioning

confidence: 99%

Development, in vitro validation and human application of a novel method to identify arrhythmia mechanisms: The stochastic trajectory analysis of ranked signals mapping method

Honarbakhsh

Hunter

Finlay

et al. 2019

Cardiovasc electrophysiol

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Introduction Stochastic trajectory analysis of ranked signals (STAR) is a novel method for mapping arrhythmia. The aim was to describe its development and validation as a mapping tool. Methods and Results The method ranks electrodes in terms of the proportion of the time they lead relative to neighboring electrodes and ascribes a predominant direction of activation between electrodes. This was conceived with the aim of mapping atrial fibrillation (AF) drivers. Validation of this approach was performed in stages. First, in vitro simultaneous multi‐electrode array and optical mapping were performed on spontaneously fibrillating HL1 cell cultures, to determine if such a method would be able to determine early sites of activation (ESA). A clinical study acquiring unipolar electrograms using a 64‐pole basket for the purposes of STAR mapping in patients undergoing atrial tachycardia (AT) ablation. STAR maps were analyzed by physicians to see if arrhythmia mechanisms could be correctly determined. Mapping was then repeated during atrial pacing. STAR mapping of in vitro activation sequences accurately correlated to the optical maps of planar and rotational activation. Thirty‐two ATs were mapped in 25 patients. The ESA accurately identified focal/micro‐reentrant ATs and the mechanism of macro‐reentrant ATs was effectively demonstrated. STAR method accurately identified four pacing sites in all patients. Conclusions This novel STAR method correlated well with the gold standard of optical mapping in vitro and was able to accurately identify AT mechanisms. Further analysis is needed to determine whether the method might be of use mapping AF.

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“…Re-entry anchor location and driver formation may also depend on electrophysiology, conduction velocity dynamics, cardiac wavelength and anisotropy. 52,[121][122][123][124] approach that aims to streamline activation patterns. 127 Roney et al…”

Section: Differentiating Between Mechanisms Using Limited Data and Inmentioning

confidence: 99%

Challenges Associated with Interpreting Mechanisms of AF

Roney

Wit

Peters

2020

Arrhythm Electrophysiol Rev

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Determining optimal treatment strategies for complex arrhythmogenesis in AF is confounded by the lack of consensus regarding the mechanisms causing AF. Studies report different mechanisms for AF, ranging from hierarchical drivers to anarchical multiple activation wavelets. Differences in the assessment of AF mechanisms are likely due to AF being recorded across diverse models using different investigational tools, spatial scales and clinical populations. The authors review different AF mechanisms, including anatomical and functional re-entry, hierarchical drivers and anarchical multiple wavelets. They then describe different cardiac mapping techniques and analysis tools, including activation mapping, phase mapping and fibrosis identification. They explain and review different data challenges, including differences between recording devices in spatial and temporal resolutions, spatial coverage and recording surface, and report clinical outcomes using different data modalities. They suggest future research directions for investigating the mechanisms underlying human AF.

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Structural remodeling and conduction velocity dynamics in the human left atrium: Relationship with reentrant mechanisms sustaining atrial fibrillation

Abstract: CV dynamics are determined largely by the extent of remodeling. Rate-dependent CV slowing sites are predominantly confined to LVZs (0.2-0.5 mV), and the resultant CV heterogeneity may promote driver formation in AF.

Cited by 54 publications

References 28 publications

Drivers in AF colocate to sites of electrogram organization and rapidity: Potential synergy between spectral analysis and STAR mapping approaches in prioritizing drivers for ablation

Drivers in AF colocate to sites of electrogram organization and rapidity: Potential synergy between spectral analysis and STAR mapping approaches in prioritizing drivers for ablation

Development, in vitro validation and human application of a novel method to identify arrhythmia mechanisms: The stochastic trajectory analysis of ranked signals mapping method

Challenges Associated with Interpreting Mechanisms of AF

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