INTRODUCTION: Atrial fibrillation (AF) often converts to and from atrial tachycardia (AT), but it is undefined if these rhythms are mechanistically related in such patients. We tested the hypothesis that critical sites for AT may be related to regional AF sources in patients with both rhythms, by mapping their locations and response to ablation on transitions to and from AF. METHODS: From 219 patients undergoing spatial mapping of AF prior to ablation at 3 centers, we enrolled 26 patients in whom AF converted to AT by ablation (n=19) or spontaneously (n=7; left atrial size 42±6cm, 38% persistent AF). Both atria were mapped in both rhythms by 64-electrode baskets, traditional activation maps and entrainment. RESULTS: Each patient had a single mapped AT (17 reentrant, 9 focal) and 3.7±1.7 AF sources. The mapped AT spatially overlapped one AF source in 88% (23/26) of patients, in left (15/23) or right (8/23) atria. AF transitioned to AT by 3 mechanisms: (a) ablation anchoring AF rotor to AT (n=13); (b) residual, unablated AF source producing AT (n=6); (c) spontaneous slowing of AF rotor leaving reentrant AT at this site without any ablation (n=7). Electrogram analysis revealed a lower peak-to-peak voltage at overlapping sites (0.36±0.2mV vs 0.49±0.2mV p=0.03). CONCLUSIONS: Mechanisms responsible for AT and AF may arise in overlapping atrial regions. This mechanistic inter-relationship may reflect structural and/or functional properties in either atrium. Future work should delineate how acceleration of an organized AT may produce AF, and whether such regions can be targeted a priori to prevent AT recurrence post AF ablation. Published by Elsevier B.V.
INTRODUCTION: Atrial fibrillation (AF) often converts to and from atrial tachycardia (AT), but it is undefined if these rhythms are mechanistically related in such patients. We tested the hypothesis that critical sites for AT may be related to regional AF sources in patients with both rhythms, by mapping their locations and response to ablation on transitions to and from AF. METHODS: From 219 patients undergoing spatial mapping of AF prior to ablation at 3 centers, we enrolled 26 patients in whom AF converted to AT by ablation (n=19) or spontaneously (n=7; left atrial size 42±6cm, 38% persistent AF). Both atria were mapped in both rhythms by 64-electrode baskets, traditional activation maps and entrainment. RESULTS: Each patient had a single mapped AT (17 reentrant, 9 focal) and 3.7±1.7 AF sources. The mapped AT spatially overlapped one AF source in 88% (23/26) of patients, in left (15/23) or right (8/23) atria. AF transitioned to AT by 3 mechanisms: (a) ablation anchoring AF rotor to AT (n=13); (b) residual, unablated AF source producing AT (n=6); (c) spontaneous slowing of AF rotor leaving reentrant AT at this site without any ablation (n=7). Electrogram analysis revealed a lower peak-to-peak voltage at overlapping sites (0.36±0.2mV vs 0.49±0.2mV p=0.03). CONCLUSIONS: Mechanisms responsible for AT and AF may arise in overlapping atrial regions. This mechanistic inter-relationship may reflect structural and/or functional properties in either atrium. Future work should delineate how acceleration of an organized AT may produce AF, and whether such regions can be targeted a priori to prevent AT recurrence post AF ablation. Published by Elsevier B.V.
Authors: Michel Haïssaguerre; Mélèze Hocini; Prashanthan Sanders; Frederic Sacher; Martin Rotter; Yoshihide Takahashi; Thomas Rostock; Li-Fern Hsu; Pierre Bordachar; Sylvain Reuter; Raymond Roudaut; Jacques Clémenty; Pierre Jaïs Journal: J Cardiovasc Electrophysiol Date: 2005-11
Authors: Sanjiv M Narayan; Michael R Franz; Paul Clopton; Etienne J Pruvot; David E Krummen Journal: Circulation Date: 2011-06-06 Impact factor: 29.690
Authors: Brian J Hansen; Jichao Zhao; Thomas A Csepe; Brandon T Moore; Ning Li; Laura A Jayne; Anuradha Kalyanasundaram; Praise Lim; Anna Bratasz; Kimerly A Powell; Orlando P Simonetti; Robert S D Higgins; Ahmet Kilic; Peter J Mohler; Paul M L Janssen; Raul Weiss; John D Hummel; Vadim V Fedorov Journal: Eur Heart J Date: 2015-06-08 Impact factor: 29.983
Authors: Sanjiv M Narayan; Matthew Wright; Nicolas Derval; Amir Jadidi; Andrei Forclaz; Isabelle Nault; Shinsuke Miyazaki; Frédéric Sacher; Pierre Bordachar; Jacques Clémenty; Pierre Jaïs; Michel Haïssaguerre; Mélèze Hocini Journal: Heart Rhythm Date: 2010-10-16 Impact factor: 6.343
Authors: Seungyup Lee; Jayakumar Sahadevan; Celeen M Khrestian; Ivan Cakulev; Alan Markowitz; Albert L Waldo Journal: Circulation Date: 2015-10-23 Impact factor: 29.690
Authors: Kentaro Yoshida; Aman Chugh; Magnus Ulfarsson; Eric Good; Michael Kuhne; Thomas Crawford; Jean F Sarrazin; Nagib Chalfoun; Darryl Wells; Warangkna Boonyapisit; Srikar Veerareddy; Sreedhar Billakanty; Wai S Wong; Krit Jongnarangsin; Frank Pelosi; Frank Bogun; Fred Morady; Hakan Oral Journal: Heart Rhythm Date: 2008-10-01 Impact factor: 6.343
Authors: Jonathan S Steinberg; Alexander Romanov; Dan Musat; Mark Preminger; Sevda Bayramova; Sergey Artyomenko; Vitaliy Shabanov; Denis Losik; Alexander Karaskov; Richard E Shaw; Evgeny Pokushalov Journal: Heart Rhythm Date: 2014-05-12 Impact factor: 6.343
Authors: Kalyanam Shivkumar; Kenneth A Ellenbogen; John D Hummel; John M Miller; Jonathan S Steinberg Journal: J Cardiovasc Electrophysiol Date: 2012-11-06