Observations From Intraatrial Recordings on the Termination of Electrically Induced Atrial Fibrillation in Humans

Sih, Haris J.; Ropella, Kristina M.; Swiryn, Steven; Gerstenfeld, Edward P.; Sahakian, Alan V.

doi:10.1111/j.1540-8159.1994.tb01490.x

Cited by 40 publications

(22 citation statements)

References 26 publications

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“…Catheter ablation strategies to restore and maintain sinus rhythm after atrial fibrillation have been developed following the success of surgical ablation procedures [9] , but their success will be critically dependent on improved understanding of atrial fibrillation mechanisms. Atrial fibrillation has been mapped in animal models [10][11][12][13][14][15][16] and humans [16][17][18][19][20][21][22][23][24] and has provided insights on the arrhythmia mechanism, but studies have been limited by the resolution of the mapping system used [25] , the extent of atrium mapped [20] , or the need for the procedure to be performed after thoracotomy [20][21][22] , which has an associated morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Endocardial mapping of atrial fibrillation in the human right atrium using a non-contact catheter

Schilling

Kadish²,

Peters

et al. 2000

European Heart Journal

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Background Endocardial mapping of atrial fibrillation in humans is limited by its low resolution and by complexities in the arrhythmia and atrial anatomy. Methods and ResultsA catheter mounted non-contact multielectrode was deployed in the right atrium of 11 patients with atrial fibrillation and used to reconstruct 3360 electrograms, superimposed onto a computer-simulated model of the endocardium, using inverse solution mathematics. This allows construction of isopotential maps of the right atrium. Patients had either sustained atrial fibrillation (n=3) for >6 months or developed atrial fibrillation during the study (n=8). Spontaneous initiation of atrial fibrillation was recorded in one patient and was demonstrated by the non-contact system to arise from two successive atrial ectopic beats from the site of a roving contact catheter. Reconstruction of electrograms recorded during atrial fibrillation was validated by comparison with contact electrograms with cross-correlation. During established atrial fibrillation, four patients predominantly had a single right atrial wave front, two had two wave fronts and five patients had three to five wave fronts for most of the time. Periods of electrical silence were seen in the right atrium in eight patients, after which, activity emerged from consistent septal sites alone, suggesting a left atrial origin. During intravenous administration of flecainide, atrial fibrillation in two patients terminated spontaneously or following pacing manoeuvres, while in the remaining patient sinus rhythm was restored via atrial tachycardia.Conclusion Non-contact mapping of the right atrium has demonstrated modes of initiation and termination of atrial fibrillation, characterized different patterns of right atrial activation in atrial fibrillation and suggests that the left atrium may sustain atrial fibrillation in some patients. Simultaneous mapping of the right and left atrium is required to further elucidate the mechanisms of human atrial fibrillation.

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Section: Introductionmentioning

confidence: 99%

Endocardial mapping of atrial fibrillation in the human right atrium using a non-contact catheter

Schilling

Kadish²,

Peters

et al. 2000

European Heart Journal

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“…Spontaneous termination of AF in patients with congestive heart failure may have different fibrillation wave characteristics and so a larger sample of episodes of AF termination, including those with different underlying atrial electrophysiological backgrounds, is needed. 19 Second, we did not evaluate the relationship between the surface ECG and the intra-atrial electrograms, but previous studies have indicated clearly that the frequency content of surface ECG correlates with that of intracardiac electrograms during AF.…”

Section: Study Limitationsmentioning

confidence: 99%

Role of Fibrillation Cycle Length in Spontaneous and Drug-Induced Termination of Human Atrial Fibrillation-Spectral Analysis of Fibrillation Waves From Surface Electrocardiogram-

Fujiki

Sakabe

Nishida

et al. 2003

Circ J

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persistently rapid rate of atrial excitation produces a progressive shortening of the atrial effective refractory period and promotes the perpetuation of atrial fibrillation (AF); 1,2 however, most paroxysmal AF terminates spontaneously within a few days despite the presence of atrial remodeling. Termination of human AF with class I antiarrhythmic drugs is preceded by an increase in fibrillation cycle length (FCL), and a failure to increase the FCL correlates with a failure to terminate the AF with medication. 3 In canine models of AF, the mapping data suggest that the increase in FCL induced by antiarrhythmic drugs may relate to fusion of wavelets, an increase in the size of reentry circuits, a decrease in circuit number and finally, termination of AF. 4 Compared with drug-induced termination, the mechanism of spontaneous termination of human AF is still unclear. It is difficult to obtain intracardiac recordings just prior to spontaneous termination of paroxysmal AF for analysis of the fibrillation waves because spontaneous

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“…Thus, in humans the termination of AF has been observed using either surface electrograms 10,11 or the measurement of the AA interval during AF. [5][6][7][8][9] Bollmann et al performed a frequency analysis of human AF using surface electrograms and the response to ibutilide; they reported that this measurement correlated with the clinical pattern of the arrhythmia and predicted the response to the administration of ibutilide. 10 Slocum et al quantified the frequency content of the fibrillatory baseline as a means to automatically identify AF.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Recently, however, the termination of AF has been attributed to a widening of the excitable gap. 4 In humans, assessment of the atrial intervals on intracardiac electrograms [5][6][7][8][9] and frequency analysis of surface electrograms, [10][11][12] and atrial intervals response to drugs, have been performed. Furthermore, the intervals between atrial electrograms during AF have been documented by direct measurement [5][6][7] and frequency analysis.…”

mentioning

confidence: 99%

Decrease in the Spatial Dispersion at the Termination of Atrial Fibrillation by Intravenous Cibenzoline

Kakugawa

Shimizu

Yamagata

et al. 2003

Circ J

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Atrial electrograms were recorded from the high right atrium, coronary sinus, and right lateral wall in 15 patients with induced atrial fibrillation (AF). Intravenous cibenzoline terminated AF in 8 patients (T group), but not in 7 patients (non-T group). The cycle length of the AF (AFCL) obtained by the autocorrelation function was measured every 5 s during the 30 s prior to the cibenzoline administration, and just before the termination of AF or at the end of the cibenzoline infusion in the non-T group. The mean AFCL, and spatial and temporal dispersion of the AFCL were then compared between the 2 groups (dispersion = standard deviation × 100 /mean AFCL). Cibenzoline significantly increased the mean AFCL and decreased the spatial dispersion in both groups. No significant difference in either the mean AFCL or temporal dispersion before or after cibenzoline was observed between the 2 groups. In addition, no significant difference in the spatial dispersion before the cibenzoline was observed, but the spatial dispersion after the cibenzoline was significantly smaller in the T group than in the non-T group. The mean AFCL, and the spatial and temporal dispersion before the cibenzoline did not predict the termination of AF. The decrease in the spatial dispersion may be the most important mechanism by which intravenous cibenzoline terminates AF.

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Observations From Intraatrial Recordings on the Termination of Electrically Induced Atrial Fibrillation in Humans

Cited by 40 publications

References 26 publications

Endocardial mapping of atrial fibrillation in the human right atrium using a non-contact catheter

Endocardial mapping of atrial fibrillation in the human right atrium using a non-contact catheter

Role of Fibrillation Cycle Length in Spontaneous and Drug-Induced Termination of Human Atrial Fibrillation-Spectral Analysis of Fibrillation Waves From Surface Electrocardiogram-

Decrease in the Spatial Dispersion at the Termination of Atrial Fibrillation by Intravenous Cibenzoline

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