Mechanistic Comparison of "Nearly Missed" Versus "On-Target" Rotor Ablation

JACC. Clinical Electrophysiology
Masatoshi YamazakiJérôme Kalifa

Abstract

This study used advanced optical mapping techniques to examine atrial fibrillation (AF) dynamics before and after 2 distinct electrogram-based ablation strategies: complex fractionated atrial electrograms (CFAEs) and DFmax/rotor ablation. Among the electrogram analytical features proposed to unravel the atrial regions that perpetuate AF, CFAEs, highest dominant frequency sites (DFmax), and, more recently, phase analysis-enabled rotor mapping have received the largest attention. Still, the mechanisms by which these approaches modulate AF dynamics and lead to AF termination are unknown. In Langendorff-perfused sheep hearts, AF was maintained by the continuous perfusion of acetylcholine and high-resolution endocardial-epicardial optical videos were recorded from the left atrial free wall and the posterior left atrium. Then, DFmax/rotor regions (n = 7), or CFAE regions harboring the highest wavebreak density (HWD) (n = 5), were targeted with a 4F ablation catheter (5 to 15 W, 30 to 60 s/point). Thereafter, we examined the changes in AF dynamics and whether AF terminated. DFmax/rotor point ablation resulted in a significant decrease in DFmax values. In 2 animals AF terminated, whereas in the remaining 5 animals the post-ablation DFm...Continue Reading

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Citations

Dec 17, 2015·Circulation. Arrhythmia and Electrophysiology·Junaid A B Zaman, Sanjiv M Narayan
Dec 20, 2017·Circulation. Arrhythmia and Electrophysiology·David CalvoCésar Morís
Nov 22, 2015·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·José Jalife
Nov 13, 2020·Journal of Cardiovascular Electrophysiology·Sachin NayyarVijay S Chauhan
Mar 22, 2021·Cardiovascular Research·Jorge G QuintanillaDavid Filgueiras-Rama
Jun 8, 2021·European Cardiology·Giulio La RosaDavid Filgueiras-Rama

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