Temporal Stability of Rotors and Atrial Activation Patterns in Persistent Human Atrial Fibrillation: A High-Density Epicardial Mapping Study of Prolonged Recordings

JACC. Clinical Electrophysiology
Tomos E WaltersJonathan M Kalman

Abstract

This study aimed to determine the spatiotemporal stability of rotors and other atrial activation patterns over 10 min in longstanding, persistent AF, along with the relationship of rotors to short cycle-length (CL) activity. The prevalence, stability, and mechanistic importance of rotors in human atrial fibrillation (AF) remain unclear. Epicardial mapping was performed in 10 patients undergoing cardiac surgery, with bipolar electrograms recorded over 10 min using a triangular plaque (area: 6.75 cm2; 117 bipoles; spacing: 2.5 mm) applied to the left atrial posterior wall (n = 9) and the right atrial free wall (n = 4). Activations were identified throughout 6 discrete 10-s segments of AF spanning 10 min, and dynamic activation mapping was performed. The distributions of 4,557 generated activation patterns within each mapped region were compared between the 6 segments. The dominant activation pattern was the simultaneous presence of multiple narrow wave fronts (26%). Twelve percent of activations represented transient rotors, seen in 85% of mapped regions with a median duration of 3 rotations. A total of 87% were centered on an area of short CL activity (<100 ms), although such activity had a positive predictive value for rotors o...Continue Reading

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Citations

Jan 14, 2018·Circulation. Arrhythmia and Electrophysiology·Junaid A B ZamanNicholas S Peters
Jun 18, 2015·Circulation. Arrhythmia and Electrophysiology·Tomos E Walters, Jonathan M Kalman
Dec 17, 2015·Circulation. Arrhythmia and Electrophysiology·Junaid A B Zaman, Sanjiv M Narayan
Apr 7, 2017·Nature Reviews. Cardiology·Stanley NattelMartin Aguilar
Nov 27, 2015·The Journal of Physiology·Sanjiv M Narayan, Junaid A B Zaman
Apr 27, 2018·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·Carola GianniAndrea Natale

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