Electrographic flow mapping for atrial fibrillation: theoretical basis and preliminary observations (original) (raw)
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Mapping of atrial fibrillation - basic research and clinical applications
2000
Despite five decades of intensive research, mechanisms initiating and stabilising atrial fibrillation (AF) are still not fully understood. Nevertheless, mapping studies, next to clinical trials and research on cellular electrophysiology, have provided key information that has led to a much more profound understanding of the arrhythmia.
Future Directions for Mapping Atrial Fibrillation
Arrhythmia & Electrophysiology Review
Mapping for AF focuses on the identification of regions of interest that may guide management and – in particular – ablation therapy. Mapping may point to specific mechanisms associated with localised scar or fibrosis, or electrical features, such as localised repetitive, rotational or focal activation. In patients in whom AF is caused by disorganised waves with no spatial predilection, as proposed in the multiwavelet theory for AF, mapping would be of less benefit. The role of AF mapping is controversial at the current time in view of the debate over the underlying mechanisms. However, recent clinical expansions of mapping technologies confirm the importance of understanding the state of the art, including limitations of current approaches and potential areas of future development.
Journal of cardiovascular electrophysiology, 2017
The mechanisms for atrial fibrillation (AF) are unclear in part because diverse mapping techniques yield diverse maps, ranging from stable organized sources to highly disordered waves. We hypothesized that AF mechanisms may be clarified if mapping techniques were compared in the same patients, and referenced to a clinical endpoint. We compared two independent AF mapping techniques in patients in whom ablation terminated persistent AF before pulmonary vein isolation (PVI). We identified 12 patients with persistent AF (61.2 ± 10.8 years, four female) in whom mapping with 64 pole baskets and technique 1 (activation/phase mapping, FIRM) identified rotational activation patterns during at least 50% of the 4-second mapping interval and targeted ablation at these rotational sites terminated AF to sinus rhythm (n = 10) or atrial tachycardia. We analyzed the unipolar electrograms of these patients to determine phase maps of activation by an independent technique 2 (Kuklik, Schotten et al., I...
Circulation. Arrhythmia and electrophysiology, 2018
Clinical outcomes after ablation of persistent atrial fibrillation remain suboptimal. Identification of AF drivers using a novel integrated mapping technique may be crucial to ameliorate the clinical outcome. Persistent AF patients were prospectively enrolled to undergo high-density electrophysiological mapping to identify repetitive-regular activities (RRas) before modified circumferential pulmonary vein (PV) ablation. They have been randomly assigned (1:1 ratio) to ablation of RRa followed by modified circumferential PV ablation (mapping group; n=41) or modified circumferential PV ablation alone (control group; n=40). The primary end point was freedom from arrhythmic recurrences at 1 year. In total, 81 persistent AF patients (74% male; mean age, 61.7±10.6 years) underwent mapping/ablation procedure. The regions exhibiting RRa were 479 in 81 patients (5.9±2.4 RRa per patient): 232 regions in the mapping group (n=41) and 247 in the control group (n=40). Overall, 185 of 479 (39%) RRa...
Journal of cardiovascular electrophysiology, 2018
To investigate mechanisms by which atrial fibrillation (AF) may terminate during ablation near the pulmonary veins before the veins are isolated (PVI). It remains unstudied how AF may terminate during ablation before PVs are isolated, or how patients with PV reconnection can be arrhythmia-free. We studied patients in whom PV antral ablation terminated AF before PVI, using 2 independent mapping methods. We studied patients with AF referred for ablation, in whom bi-atrial contact basket electrograms were studied by both an activation/phase mapping method and by a second validated mapping method reported not to create false rotational activity. In 22 patients (age 60.1±10.4, 36% persistent AF), ablation at sites near the PVs terminated AF (77% to sinus rhythm) prior to PVI. AF propagation revealed rotational (n = 20) and focal (n = 2) patterns at sites of termination by mapping method 1 and method 2. Both methods showed organized sites that were spatially concordant (p < 0.001) with...
Introduction: Dominant frequency (DF) analysis has been widely used to understand the pathophysiology of atrial fibrillation (AF). An interactive digital platform was developed to provide real-time DF mapping during DF-guided AF ablation. Methods: A user oriented graphic interface was developed in Matlab for real-time analysis of data exported from the non-contact balloon array (St. Jude Ensite Velocity System). The platform performs QRST subtraction on all electrograms (EGM) and Fast Fourier transform with 4 seconds windows (50% overlap) to compute DF, organization index (OI), regularity index (RI) and phase. DF, OI and RI of each window can be colour-coded and plotted on a 3D left atrium mesh, and 3D phase movies can also be played using a slider. High DF areas and the trajectory of their centres of gravity can be shown per individual window. Also any EGM of interest on the 3D mesh is easily accessible using the mouse. Results: 30 seconds of EGM data sampled at 2034.5 Hz with 2048...
Pacing and Clinical Electrophysiology, 2018
Introduction: Adjunctive driver-guided ablation in addition to pulmonary vein isolation has been proposed as a strategy to improve procedural success and outcomes for various populations with atrial fibrillation (AF). First, this study aimed to evaluate the different mapping techniques for driver/rotor identification and second to evaluate the benefits of driver/rotor-guided ablation in patients with paroxysmal and persistent AF (PerAF).
Circulation. Arrhythmia and electrophysiology, 2013
The foundation for successful arrhythmia ablation is the mapping of electric propagation to identify underlying mechanisms. In atrial fibrillation (AF), however, mapping is difficult so that ablation has often targeted electrogram features, with mixed results. We hypothesized that wide field-of-view (panoramic) mapping of both atria would identify causal mechanisms for AF and allow interpretation of local electrogram features, including complex fractionated atrial electrograms (CFAE). Contact mapping was performed using biatrial multipolar catheters in 36 AF subjects (29 persistent). Stable AF rotors (spiral waves) or focal sources were seen in 35 of 36 cases and targeted for ablation (focal impulse and rotor modulation) before pulmonary vein isolation. In 31 of 36 subjects (86.1%), AF acutely terminated (n=20; 16 to sinus rhythm) or organized (n=11; 19±8% slowing) with 2.5 minutes focal impulse and rotor modulation (interquartile range, 1.0-3.1) at one source, defined as the primar...