Transmural characteristics of atrial fibrillation in canine models of structural and electrical atrial remodeling assessed by simultaneous epicardial and endocardial mapping

Everett, Thomas H.; Wilson, Emily; Hulley, George S.; Olgin, Jeffrey E.

doi:10.1016/j.hrthm.2009.12.030

Cited by 28 publications

(18 citation statements)

References 34 publications

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“…The various patterns could further differ between the endocardial and epicardial surfaces, suggesting the existence of transmural propagation (Everett et al, 2010) and linked to increased stability of AF (Eckstein et al, 2011). In Fig.…”

Section: Resultsmentioning

confidence: 99%

Ectopic and reentrant activation patterns in the posterior left atrium during stretch-related atrial fibrillation

Yamazaki¹,

Filgueiras-Rama²,

Berenfeld³

et al. 2012

Progress in Biophysics and Molecular Biology

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in humans and is predicted to dramatically increase its prevalence in the future. There is experimental evidence that increasing stretch increases the dominance of the pulmonary veins (PVs) during AF in isolated hearts and ectopic activity in the isolated PVs, but the ionic mechanisms underlying such effects are not clear and the ability of the PVs to favorably host functional reentry during stretch cannot be excluded. We used a combination of endocardial–epicardial optical mapping with phase and spectral analysis to study stretch-related AF (SRAF) in normal isolated sheep hearts. We have found rapid AF sources in the posterior left atrium (PLA) and PV region and their activation frequency and level of organization correlated with intra-atrial pressure. Analysis of the surfaces’ optical mapping data in the phase domain reveals that activation of the PLA consisted of alternating patterns of breakthroughs, reentries and relatively simple waves swiping across the mapped field. The patterns on the endocardial and epicardial PLA surface at any given moment of time of the SRAF could be either identical or not identical, and the activity in the thickness of the PLA wall is hypothesized to conform to either ectopic discharge or scroll waves, but a definite evidence for the presence of such mechanisms is currently lacking. Thus the understanding of the manner by which the mechano-electric feedback effects in the PLA, including the PVs, become important in the initiation and maintenance of AF requires further detailed investigation.

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Section: Resultsmentioning

confidence: 99%

Ectopic and reentrant activation patterns in the posterior left atrium during stretch-related atrial fibrillation

Yamazaki¹,

Filgueiras-Rama²,

Berenfeld³

et al. 2012

Progress in Biophysics and Molecular Biology

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“…The heart-specific uncoupling of atrial layers is exacerbated by AF progression and cardiac comorbidities and would lead to significant differences between local epicardial vs endocardial electrode recordings, especially during fast AF rhythm(6;20). Additionally, the substrate in which the mapping is performed may influence the relationship of activation between the endocardial and epicardial surfaces, as shown in a canine AF model by Everett et al(24). Thus, only simultaneous endo-epicardial electrophysiological mapping approaches directly integrated with high-resolution structural mapping can provide definitive answers on transmural conduction differences and resolve AF mechanisms(7;10;22).…”

Section: D Human Atrial Structure Fibrosis and Electrical Conductionmentioning

confidence: 99%

Atrial fibrillation driver mechanisms: Insight from the isolated human heart

Csepe

Hansen

Fedorov

2017

Trends in Cardiovascular Medicine

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Although there have been great technological advances in the treatment of atrial fibrillation (AF), current therapies remain limited due to a narrow understanding of AF mechanisms in the human heart. This review will highlight our recent studies on explanted human hearts where we developed and employed a novel functional-structural mapping approach by integrating high-resolution simultaneous endo-epicardial and panoramic optical mapping with 3D gadolinium-enhanced MRI to define the spatiotemporal characteristics of AF drivers and their structural substrates. The results allow us to postulate that the primary mechanism of AF maintenance in human hearts is a limited number of localized intramural microanatomic reentrant AF drivers anchored to heart-specific 3D fibrotically-insulated myobundle tracks, which may remain hidden to clinical single surface electrode mapping. We suggest that ex vivo human heart studies, by using an integrated 3D functional and structural mapping approach, will help to reveal defining features of AF drivers as well as validate and improve clinical approaches to detect and target these AF drivers in patients with cardiac diseases.

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“…Multiple investigators have demonstrated in animal models that there is a potential for not just side-to-side or end-to-end dissociation but also endo-epicardial dissociation of conduction leading toward transmural wavelet reentry. 15,16 This has not been solved in the context of modern mapping techniques.…”

Section: Limitation Of Computational Methodsmentioning

confidence: 99%

Creating Order From Chaos

Kancharla

Kapa

Asirvatham

2016

Circ: Arrhythmia and Electrophysiology

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Transmural characteristics of atrial fibrillation in canine models of structural and electrical atrial remodeling assessed by simultaneous epicardial and endocardial mapping

Abstract: Background-Epicardial mapping has demonstrated that atrial substrate may play a role in the characteristics of the resulting atrial fibrillation (AF). However, it is not known if these differences also occur in three dimensions.

Cited by 28 publications

References 34 publications

Ectopic and reentrant activation patterns in the posterior left atrium during stretch-related atrial fibrillation

Ectopic and reentrant activation patterns in the posterior left atrium during stretch-related atrial fibrillation

Atrial fibrillation driver mechanisms: Insight from the isolated human heart

Creating Order From Chaos

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