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Computational Mapping Identifies Localized Mechanisms for Ablation of Atrial Fibrillation

Atrial fibrillation (AF) is the most common heart rhythm disorder in the Western world and a common cause of hospitalization and death. Pharmacologic and non-pharmacologic therapies have met with limited success, in part due to an incomplete understanding of the underlying mechanisms for AF. AF is t...

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Autores principales: Narayan, Sanjiv M., Krummen, David E., Enyeart, Michael W., Rappel, Wouter-Jan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3458823/
https://www.ncbi.nlm.nih.gov/pubmed/23049929
http://dx.doi.org/10.1371/journal.pone.0046034
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author Narayan, Sanjiv M.
Krummen, David E.
Enyeart, Michael W.
Rappel, Wouter-Jan
author_facet Narayan, Sanjiv M.
Krummen, David E.
Enyeart, Michael W.
Rappel, Wouter-Jan
author_sort Narayan, Sanjiv M.
collection PubMed
description Atrial fibrillation (AF) is the most common heart rhythm disorder in the Western world and a common cause of hospitalization and death. Pharmacologic and non-pharmacologic therapies have met with limited success, in part due to an incomplete understanding of the underlying mechanisms for AF. AF is traditionally characterized by spatiotemporally disorganized electrical activation and, although initiating triggers for AF are described, it is unclear whether AF is sustained by spatially meandering continuous excitation (re-entrant waves), localized electrical sources within the atria, or some other mechanism. This has limited therapeutic options for this condition. Here we show that human AF is predominantly caused by a small number (1.8±0.9) of localized re-entrant waves or repetitive focal beats, that remain stable with limited spatial migration over prolonged periods of time. Radiofrequency ablation that selectively targeted the sites of these sources was able to immediately terminate fibrillation and eliminate the arrhythmia with high success. Our results show that human AF, despite apparent spatiotemporal disorganization, is often perpetuated by a few spatially-constrained and temporally conserved sources whose targeted ablation can eliminate this complex rhythm disorder.
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spelling pubmed-34588232012-10-03 Computational Mapping Identifies Localized Mechanisms for Ablation of Atrial Fibrillation Narayan, Sanjiv M. Krummen, David E. Enyeart, Michael W. Rappel, Wouter-Jan PLoS One Research Article Atrial fibrillation (AF) is the most common heart rhythm disorder in the Western world and a common cause of hospitalization and death. Pharmacologic and non-pharmacologic therapies have met with limited success, in part due to an incomplete understanding of the underlying mechanisms for AF. AF is traditionally characterized by spatiotemporally disorganized electrical activation and, although initiating triggers for AF are described, it is unclear whether AF is sustained by spatially meandering continuous excitation (re-entrant waves), localized electrical sources within the atria, or some other mechanism. This has limited therapeutic options for this condition. Here we show that human AF is predominantly caused by a small number (1.8±0.9) of localized re-entrant waves or repetitive focal beats, that remain stable with limited spatial migration over prolonged periods of time. Radiofrequency ablation that selectively targeted the sites of these sources was able to immediately terminate fibrillation and eliminate the arrhythmia with high success. Our results show that human AF, despite apparent spatiotemporal disorganization, is often perpetuated by a few spatially-constrained and temporally conserved sources whose targeted ablation can eliminate this complex rhythm disorder. Public Library of Science 2012-09-26 /pmc/articles/PMC3458823/ /pubmed/23049929 http://dx.doi.org/10.1371/journal.pone.0046034 Text en © 2012 Narayan et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Narayan, Sanjiv M.
Krummen, David E.
Enyeart, Michael W.
Rappel, Wouter-Jan
Computational Mapping Identifies Localized Mechanisms for Ablation of Atrial Fibrillation
title Computational Mapping Identifies Localized Mechanisms for Ablation of Atrial Fibrillation
title_full Computational Mapping Identifies Localized Mechanisms for Ablation of Atrial Fibrillation
title_fullStr Computational Mapping Identifies Localized Mechanisms for Ablation of Atrial Fibrillation
title_full_unstemmed Computational Mapping Identifies Localized Mechanisms for Ablation of Atrial Fibrillation
title_short Computational Mapping Identifies Localized Mechanisms for Ablation of Atrial Fibrillation
title_sort computational mapping identifies localized mechanisms for ablation of atrial fibrillation
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3458823/
https://www.ncbi.nlm.nih.gov/pubmed/23049929
http://dx.doi.org/10.1371/journal.pone.0046034
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