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Diverse activation patterns during persistent atrial fibrillation by noncontact charge‐density mapping of human atrium

BACKGROUND: Global simultaneous recording of atrial activation during atrial fibrillation (AF) can elucidate underlying mechanisms contributing to AF maintenance. A better understanding of these mechanisms may allow for an individualized ablation strategy to treat persistent AF. The study aims to ch...

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Autores principales: Shi, Rui, Chen, Zhong, Butcher, Charlie, Zaman, Junaid AB, Boyalla, Vennela, Wang, Yi Kan, Riad, Omar, Sathishkumar, Anitha, Norman, Mark, Haldar, Shouvik, Jones, David G, Hussain, Wajid, Markides, Vias, Wong, Tom
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411208/
https://www.ncbi.nlm.nih.gov/pubmed/32782641
http://dx.doi.org/10.1002/joa3.12361
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author Shi, Rui
Chen, Zhong
Butcher, Charlie
Zaman, Junaid AB
Boyalla, Vennela
Wang, Yi Kan
Riad, Omar
Sathishkumar, Anitha
Norman, Mark
Haldar, Shouvik
Jones, David G
Hussain, Wajid
Markides, Vias
Wong, Tom
author_facet Shi, Rui
Chen, Zhong
Butcher, Charlie
Zaman, Junaid AB
Boyalla, Vennela
Wang, Yi Kan
Riad, Omar
Sathishkumar, Anitha
Norman, Mark
Haldar, Shouvik
Jones, David G
Hussain, Wajid
Markides, Vias
Wong, Tom
author_sort Shi, Rui
collection PubMed
description BACKGROUND: Global simultaneous recording of atrial activation during atrial fibrillation (AF) can elucidate underlying mechanisms contributing to AF maintenance. A better understanding of these mechanisms may allow for an individualized ablation strategy to treat persistent AF. The study aims to characterize left atrial endocardial activation patterns during AF using noncontact charge‐density mapping. METHODS: Twenty‐five patients with persistent AF were studied. Activation patterns were characterized into three subtypes: (i) focal with centrifugal activation (FCA); (ii) localized rotational activation (LRA); and (iii) localized irregular activation (LIA). Continuous activation patterns were analyzed and distributed in 18 defined regions in the left atrium. RESULTS: A total of 144 AF segments with 1068 activation patterns were analyzed. The most common pattern during AF was LIA (63%) which consists of four disparate features of activation: slow conduction (45%), pivoting (30%), collision (16%), and acceleration (7%). LRA was the second‐most common pattern (20%). FCA accounted for 17% of all activations, arising frequently from the pulmonary veins (PVs)/ostia. A majority of patients (24/25; 96%) showed continuous and highly dynamic patterns of activation comprising multiple combinations of FCA, LRA, and LIA, transitioning from one to the other without a discernible order. Preferential conduction areas were typically seen in the mid‐anterior (48%) and lower‐posterior (40%) walls. CONCLUSION: Atrial fibrillation is characterized by heterogeneous activation patterns identified in PV‐ostia and non‐PV regions throughout the LA at varying locations between individuals. Clinical implications of individualized ablation strategies guided by charge‐density mapping need to be determined.
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spelling pubmed-74112082020-08-10 Diverse activation patterns during persistent atrial fibrillation by noncontact charge‐density mapping of human atrium Shi, Rui Chen, Zhong Butcher, Charlie Zaman, Junaid AB Boyalla, Vennela Wang, Yi Kan Riad, Omar Sathishkumar, Anitha Norman, Mark Haldar, Shouvik Jones, David G Hussain, Wajid Markides, Vias Wong, Tom J Arrhythm Original Articles BACKGROUND: Global simultaneous recording of atrial activation during atrial fibrillation (AF) can elucidate underlying mechanisms contributing to AF maintenance. A better understanding of these mechanisms may allow for an individualized ablation strategy to treat persistent AF. The study aims to characterize left atrial endocardial activation patterns during AF using noncontact charge‐density mapping. METHODS: Twenty‐five patients with persistent AF were studied. Activation patterns were characterized into three subtypes: (i) focal with centrifugal activation (FCA); (ii) localized rotational activation (LRA); and (iii) localized irregular activation (LIA). Continuous activation patterns were analyzed and distributed in 18 defined regions in the left atrium. RESULTS: A total of 144 AF segments with 1068 activation patterns were analyzed. The most common pattern during AF was LIA (63%) which consists of four disparate features of activation: slow conduction (45%), pivoting (30%), collision (16%), and acceleration (7%). LRA was the second‐most common pattern (20%). FCA accounted for 17% of all activations, arising frequently from the pulmonary veins (PVs)/ostia. A majority of patients (24/25; 96%) showed continuous and highly dynamic patterns of activation comprising multiple combinations of FCA, LRA, and LIA, transitioning from one to the other without a discernible order. Preferential conduction areas were typically seen in the mid‐anterior (48%) and lower‐posterior (40%) walls. CONCLUSION: Atrial fibrillation is characterized by heterogeneous activation patterns identified in PV‐ostia and non‐PV regions throughout the LA at varying locations between individuals. Clinical implications of individualized ablation strategies guided by charge‐density mapping need to be determined. John Wiley and Sons Inc. 2020-05-20 /pmc/articles/PMC7411208/ /pubmed/32782641 http://dx.doi.org/10.1002/joa3.12361 Text en © 2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Shi, Rui
Chen, Zhong
Butcher, Charlie
Zaman, Junaid AB
Boyalla, Vennela
Wang, Yi Kan
Riad, Omar
Sathishkumar, Anitha
Norman, Mark
Haldar, Shouvik
Jones, David G
Hussain, Wajid
Markides, Vias
Wong, Tom
Diverse activation patterns during persistent atrial fibrillation by noncontact charge‐density mapping of human atrium
title Diverse activation patterns during persistent atrial fibrillation by noncontact charge‐density mapping of human atrium
title_full Diverse activation patterns during persistent atrial fibrillation by noncontact charge‐density mapping of human atrium
title_fullStr Diverse activation patterns during persistent atrial fibrillation by noncontact charge‐density mapping of human atrium
title_full_unstemmed Diverse activation patterns during persistent atrial fibrillation by noncontact charge‐density mapping of human atrium
title_short Diverse activation patterns during persistent atrial fibrillation by noncontact charge‐density mapping of human atrium
title_sort diverse activation patterns during persistent atrial fibrillation by noncontact charge‐density mapping of human atrium
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411208/
https://www.ncbi.nlm.nih.gov/pubmed/32782641
http://dx.doi.org/10.1002/joa3.12361
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