Sites of Focal Atrial Activity Characterized by Endocardial Mapping During Atrial Fibrillation

Takahashi, Yoshihide; Hocini, Mélèze; O’Neill, Mark; Sanders, Prashanthan; Rotter, Martin; Rostock, Thomas; Jönsson, Anders; Sacher, Frédéric; Clémenty, Jacques; Jaı̈s, Pierre; Haı̈ssaguerre, Michel

doi:10.1016/j.jacc.2005.12.068

Cited by 36 publications

(28 citation statements)

References 16 publications

(19 reference statements)

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“…13,18 Takahashi et al analyzed electrogram characteristics associated with AFCL prolongation during CFAE ablation. 13 Although dominant frequency and electrogram amplitude had no effect, fractionated activity for Ն70% of the recording was associated with AFCL prolongation.…”

Section: Discussionmentioning

confidence: 99%

“…17 AFCL has been used by others to quantify response to ablation, and an increase of Ն5 to 6 ms has been regarded as significant. 13,14,18 Mean AFCL was determined manually over 30 cycles from bipolar electrograms recorded at the apex of the left and right atrial appendages (where electrograms are high amplitude and AFCL is unambiguous) before and after each CFAE lesion.…”

Section: Targeting Of Cfaementioning

confidence: 99%

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Characterization of Fractionated Atrial Electrograms Critical for Maintenance of Atrial Fibrillation

Hunter

Diab

Tayebjee

et al. 2011

Circ: Arrhythmia and Electrophysiology

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Background-Whether ablation of complex fractionated atrial electrograms (CFAE) modifies atrial fibrillation (AF) by eliminating drivers or atrial debulking remains unknown. This randomized study aimed to determine the effect of ablating different CFAE morphologies compared with normal electrograms (ie, debulking normal tissue) on the cycle length of persistent AF (AFCL). Methods and Results-After pulmonary vein isolation left and right atrial CFAE were targeted, until termination of AF or abolition of CFAE before DC cardioversion. Ten-second electrograms were classified according to a validated scale, with grade 1 being most fractionated and grade 5 normal. Patients were randomly assigned to have CFAE grades eliminated sequentially, from grade 1 to 5 (group 1) or grade 5 to 1 (group 2). An increase in AFCL (mean of left and right atrial appendage) Ն5 ms after a lesion was regarded as significant. CFAE (nϭ968) were targeted in 20 patients. AFCL increased after targeting 51Ϯ35% of grade 1 CFAE, 30Ϯ15% grade 2, 12Ϯ5% grade 3, 33Ϯ12% grade 4, and 8Ϯ15% grade 5 CFAE (PϽ0.01 for grades 1, 2, and 4 versus 5; 3 versus 5, not significant). The proportion of lesions causing AFCL prolongation was unaffected by the order in which CFAE were targeted. Conclusions-Targeting

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Section: Discussionmentioning

confidence: 99%

Section: Targeting Of Cfaementioning

confidence: 99%

Characterization of Fractionated Atrial Electrograms Critical for Maintenance of Atrial Fibrillation

Hunter

Diab

Tayebjee

et al. 2011

Circ: Arrhythmia and Electrophysiology

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“…30 These continuous or intermittent focal activities were commonly demonstrated in patients with paroxysmal and persistent AF, and, although the mechanisms of these focal activities could not be specified, triggered activity or abnormal automaticity may be the cause of the mechanism. 31 Whether or not the location of the arrhythymogenic foci is related to those sites with focal activity remains unknown; however, there is the possibility that the mechanism of enhanced triggered activity due to AF persistency may promote the sustainability of AF.…”

Section: Comparison Of the Pathogenesis Between Paroxysmal And Persismentioning

confidence: 99%

Multiple Arrhythmogenic Foci Associated With the Development of Perpetuation of Atrial Fibrillation

Kurotobi

Iwakura

Inoue

et al. 2010

Circ: Arrhythmia and Electrophysiology

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Background-The presence of multiple arrhythmogenic sources may be associated with the perpetuation of atrial fibrillation (AF). In this study, we investigated the hypothesis that multiple foci might be involved in the development of AF persistency. Methods and Results-Two hundred fourteen consecutive patients with AF undergoing catheter ablation were enrolled in this study. The location of the arrhythmogenic foci was determined using simultaneous recordings from multipolar catheters before and after pulmonary vein isolation during an isoproterenol administration. We detected 500 arrhythmogenic foci (263 foci as AF initiators, and 237 foci as non-AF initiators). High-dose isoproterenol infusions (ranging from 2 to 20 g/min) revealed potential arrhythmogenic foci, especially non-pulmonary vein foci (55%). Persistent AF was more highly associated with an incidence of multiple (Ͼ2) foci than paroxysmal AF (88% versus 65%, Pϭ0.002), and a multivariate analysis demonstrated that multiple foci (Ͼ2) were an independent contributing factor for persistent AF (odds ratio; 95% confidence interval, 4.69; 1.82 to 12.09, PϽ0.001). In paroxysmal AF, the number of foci was higher in patients with long-term AF (Ͼ24 hours) than in those with short-lasting AF (2.64Ϯ0.14 versus 1.77Ϯ0.16, Pϭ0.001). In the persistent AF group, the patients with short-lasting AF (Ͻ12 months) had a greater number of foci than did those with long-term AF (Ͼ12 months) (3.62Ϯ0.15 versus 1.92Ϯ0.16, Pϭ0.04). Conclusions-Multiple foci were likely to be involved in the development of persistent AF. However, if AF persisted for Ͼ12 months, they may not have had a significant effect on the AF perpetuation. (Circ Arrhythm Electrophysiol. 2010; 3:39-45.)

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“…The core and trajectory of reentrant drivers and focal sources are depicted on the patient-specific biatrial geometry (see Figure 1A-C). 28,32 The number of foci and reentry through the total duration of all AF windows are displayed on cumulative driver-density maps.…”

Section: Non-invasive Body Surface Mapping Analysis For Atrial Fibrilmentioning

confidence: 99%

“…Reentrant drivers are more preferentially targeted than focal drivers because of the fact that sites harbouring atrial focal activities during AF were not found to be strongly associated with AF termination. 32 Also, stable drivers with good quality signals on the non-invasive map are targeted regardless of their type. AF sustained after driver-based ablation is electrocardioverted.…”

Section: The Endpoint Of the Procedures Is Af Termination (Sinus Rhythmentioning

confidence: 99%

Body Surface Mapping to Guide Atrial Fibrillation Ablation

Yamashita¹,

Mahida²,

Sellal³

et al. 2015

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF) is the most common rhythm disorder, and is strongly associated with thromboembolic events and heart failure. Over the past decade, catheter ablation of AF has advanced considerably with progressive improvement in success rates. However, interventional treatment is still challenging, especially for persistent and long-standing persistent AF. Recently, AF analysis using a non-invasive body surface mapping technique has been shown to identify localised reentrant and focal sources, which play an important role in driving and perpetuating AF. Non-invasive mapping-guided ablation has also been reported to be effective for persistent AF. In this review, we describe new clinical insights obtained from non-invasive mapping of persistent AF to guide catheter ablation.

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Sites of Focal Atrial Activity Characterized by Endocardial Mapping During Atrial Fibrillation

Abstract: Termination of AF without ablation at the sites of atrial focal activity suggests that this activity may be triggered by impulses originating from other regions, such as the pulmonary veins.

Cited by 36 publications

References 16 publications

Characterization of Fractionated Atrial Electrograms Critical for Maintenance of Atrial Fibrillation

Characterization of Fractionated Atrial Electrograms Critical for Maintenance of Atrial Fibrillation

Multiple Arrhythmogenic Foci Associated With the Development of Perpetuation of Atrial Fibrillation

Body Surface Mapping to Guide Atrial Fibrillation Ablation

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