Pawel Kuklik1, Dennis H Lau2, Anand N Ganesan2, Anthony G Brooks2, Prashanthan Sanders2. 1. Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Cardiology, University Hospital Eppendorf, Hamburg, Germany. Electronic address: pawel.kuklik@adelaide.edu.au. 2. Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
Abstract
BACKGROUND: Temporal dynamics of electrical wave propagation during AF is unknown. There are reports of transient linking of atrial activation. We aim to characterize temporal dynamics of wave propagation patterns during AF in an established chronically remodeled substrate. METHODS: Bi-atrial epicardial mapping of AF (mean duration 62±61s) was performed in 13 sheep with induced hypertension using custom-designed plaques. Wave propagation patterns were classified into periods of repetitive activity termed modes. RESULTS: In total, we identified 9241 distinct depolarization events which were classified as: passing wave (69% occurrence, 68.6% of total time), point source (20.4%, 13.1%), wave collision (4%, 2.8%), re-entrant wave (0.7%, 6.3%), half-rotation (2.9%, 4.4%), wave splitting (2.7%, 4.3%), conduction block (0.05%, 0.03%) and figure of eight reentry (0.05%, 0.05%). Episodes of re-entrant activity had mean length 701±1012ms. A total of 435 modes of distinct periods of repetitive activity were detected (121 in LA and 314 in RA). Looking at temporal changes between modes, we found a preferential transition: change between train of waves propagating from direction of coronary sinus and reentrant activity. High density mapping of the hypertensive fibrillating atria observed 20% point sources and 0.7% of reentrant activation which may have served as drivers of AF. Remaining activations were peripheral waves. Majority of the activation was organized into events of transient linking with existence of preferential types of transitions. CONCLUSIONS: These findings support the importance of substrate based regions of anatomically or functionally determined preferential conduction in the maintenance of AF.
BACKGROUND: Temporal dynamics of electrical wave propagation during AF is unknown. There are reports of transient linking of atrial activation. We aim to characterize temporal dynamics of wave propagation patterns during AF in an established chronically remodeled substrate. METHODS: Bi-atrial epicardial mapping of AF (mean duration 62±61s) was performed in 13 sheep with induced hypertension using custom-designed plaques. Wave propagation patterns were classified into periods of repetitive activity termed modes. RESULTS: In total, we identified 9241 distinct depolarization events which were classified as: passing wave (69% occurrence, 68.6% of total time), point source (20.4%, 13.1%), wave collision (4%, 2.8%), re-entrant wave (0.7%, 6.3%), half-rotation (2.9%, 4.4%), wave splitting (2.7%, 4.3%), conduction block (0.05%, 0.03%) and figure of eight reentry (0.05%, 0.05%). Episodes of re-entrant activity had mean length 701±1012ms. A total of 435 modes of distinct periods of repetitive activity were detected (121 in LA and 314 in RA). Looking at temporal changes between modes, we found a preferential transition: change between train of waves propagating from direction of coronary sinus and reentrant activity. High density mapping of the hypertensive fibrillating atria observed 20% point sources and 0.7% of reentrant activation which may have served as drivers of AF. Remaining activations were peripheral waves. Majority of the activation was organized into events of transient linking with existence of preferential types of transitions. CONCLUSIONS: These findings support the importance of substrate based regions of anatomically or functionally determined preferential conduction in the maintenance of AF.
Authors: Christopher A B Kowalewski; Fatemah Shenasa; Miguel Rodrigo; Paul Clopton; Gabriela Meckler; Mahmood I Alhusseini; Mark A Swerdlow; Vijay Joshi; Samir Hossainy; Junaid A B Zaman; Tina Baykaner; Albert J Rogers; Johannes Brachmann; John M Miller; David E Krummen; William H Sauer; Nicholas S Peters; Paul J Wang; Sanjiv M Narayan Journal: Circ Arrhythm Electrophysiol Date: 2018-06
Authors: M Swerdlow; M Tamboli; M I Alhusseini; N Moosvi; A J Rogers; G Leef; P J Wang; A Rillig; J Brachmann; W H Sauer; P Ruppersberg; S M Narayan; T Baykaner Journal: Pacing Clin Electrophysiol Date: 2019-03-24 Impact factor: 1.976
Authors: George Leef; Fatemah Shenasa; Neal K Bhatia; Albert J Rogers; William Sauer; John M Miller; Mark Swerdlow; Mallika Tamboli; Mahmood I Alhusseini; Erin Armenia; Tina Baykaner; Johannes Brachmann; Mintu P Turakhia; Felipe Atienza; Wouter-Jan Rappel; Paul J Wang; Sanjiv M Narayan Journal: Circ Arrhythm Electrophysiol Date: 2019-07-29
Authors: Sanjiv M Narayan; Mohan N Vishwanathan; Christopher A B Kowalewski; Tina Baykaner; Miguel Rodrigo; Junaid A B Zaman; Paul J Wang Journal: Rev Port Cardiol Date: 2017-11-08 Impact factor: 1.374
Authors: Mahmood Alhusseini; David Vidmar; Gabriela L Meckler; Christopher A Kowalewski; Fatemah Shenasa; Paul J Wang; Sanjiv M Narayan; Wouter-Jan Rappel Journal: J Cardiovasc Electrophysiol Date: 2017-03-20