Tomos E Walters1, Geoffrey Lee1, Gwilym Morris2, Steven Spence2, Marco Larobina3, Victoria Atkinson3, Phillip Antippa3, John Goldblatt3, Alistair Royse4, Michael O'Keefe3, Prashanthan Sanders5, Joseph B Morton1, Peter M Kistler6, Jonathan M Kalman7. 1. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia. 2. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia. 3. Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia. 4. Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia. 5. Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. 6. Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Cardiology, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Australia. 7. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia. Electronic address: jon.kalman@mh.org.au.
Abstract
OBJECTIVES: This study aimed to determine the spatiotemporal stability of rotors and other atrial activation patterns over 10 min in longstanding, persistent AF, along with the relationship of rotors to short cycle-length (CL) activity. BACKGROUND: The prevalence, stability, and mechanistic importance of rotors in human atrial fibrillation (AF) remain unclear. METHODS: Epicardial mapping was performed in 10 patients undergoing cardiac surgery, with bipolar electrograms recorded over 10 min using a triangular plaque (area: 6.75 cm2; 117 bipoles; spacing: 2.5 mm) applied to the left atrial posterior wall (n = 9) and the right atrial free wall (n = 4). Activations were identified throughout 6 discrete 10-s segments of AF spanning 10 min, and dynamic activation mapping was performed. The distributions of 4,557 generated activation patterns within each mapped region were compared between the 6 segments. RESULTS: The dominant activation pattern was the simultaneous presence of multiple narrow wave fronts (26%). Twelve percent of activations represented transient rotors, seen in 85% of mapped regions with a median duration of 3 rotations. A total of 87% were centered on an area of short CL activity (<100 ms), although such activity had a positive predictive value for rotors of only 0.12. The distribution of activation patterns and wave-front directionality were highly stable over time, with a single dominant pattern within a 10-s AF segment recurring across all 6 segments in 62% of mapped regions. CONCLUSIONS: In patients with longstanding, persistent AF, activation patterns are spatiotemporally stable over 10 min. Transient rotors can be demonstrated in the majority of mapped regions, are spatiotemporally associated with short CL activity, and, when recurrent, demonstrate anatomical determinism.
OBJECTIVES: This study aimed to determine the spatiotemporal stability of rotors and other atrial activation patterns over 10 min in longstanding, persistent AF, along with the relationship of rotors to short cycle-length (CL) activity. BACKGROUND: The prevalence, stability, and mechanistic importance of rotors in human atrial fibrillation (AF) remain unclear. METHODS: Epicardial mapping was performed in 10 patients undergoing cardiac surgery, with bipolar electrograms recorded over 10 min using a triangular plaque (area: 6.75 cm2; 117 bipoles; spacing: 2.5 mm) applied to the left atrial posterior wall (n = 9) and the right atrial free wall (n = 4). Activations were identified throughout 6 discrete 10-s segments of AF spanning 10 min, and dynamic activation mapping was performed. The distributions of 4,557 generated activation patterns within each mapped region were compared between the 6 segments. RESULTS: The dominant activation pattern was the simultaneous presence of multiple narrow wave fronts (26%). Twelve percent of activations represented transient rotors, seen in 85% of mapped regions with a median duration of 3 rotations. A total of 87% were centered on an area of short CL activity (<100 ms), although such activity had a positive predictive value for rotors of only 0.12. The distribution of activation patterns and wave-front directionality were highly stable over time, with a single dominant pattern within a 10-s AF segment recurring across all 6 segments in 62% of mapped regions. CONCLUSIONS: In patients with longstanding, persistent AF, activation patterns are spatiotemporally stable over 10 min. Transient rotors can be demonstrated in the majority of mapped regions, are spatiotemporally associated with short CL activity, and, when recurrent, demonstrate anatomical determinism.
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
Authors: Junaid A B Zaman; William H Sauer; Mahmood I Alhusseini; Tina Baykaner; Ryan T Borne; Christopher A B Kowalewski; Sonia Busch; Paul C Zei; Shirley Park; Mohan N Viswanathan; Paul J Wang; Johannes Brachmann; David E Krummen; John M Miller; Wouter Jan Rappel; Sanjiv M Narayan; Nicholas S Peters Journal: Circ Arrhythm Electrophysiol Date: 2018-01
Authors: Michael Tb Pope; Pawel Kuklik; Andre Briosa E Gala; Milena Leo; Michael Mahmoudi; John Paisey; Timothy R Betts Journal: J Cardiovasc Electrophysiol Date: 2021-07-28 Impact factor: 2.942