Journal ArticleDOI
Noninvasive Panoramic Mapping of Human Atrial Fibrillation Mechanisms: A Feasibility Report
Michel Haïssaguerre,Mélèze Hocini,Ashok J. Shah,Nicolas Derval,Frederic Sacher,Pierre Jaïs,Rémi Dubois +6 more
TLDR
This work has developed specific algorithms to identify localized sources and atrial propagation occurring simultaneously during ongoing atrial fibrillation (AF).Abstract:
Noninvasive Panoramic Mapping of Human Atrial Fibrillation MechanismsIntroduction
Recent developments in body surface mapping and computer processing have allowed noninvasive mapping of atrial activation responsible for various cardiac arrhythmias with increasingly greater resolution. We developed specific algorithms to identify localized sources and atrial propagation occurring simultaneously during ongoing atrial fibrillation (AF).
Methods and Results
We report the feasibility of noninvasive panoramic mapping of human AF mechanisms and its validation by successful ablation. We used a commercially available mapping system using an array of 252 body surface electrodes and noncontrast thoracic CT scan to obtain high-resolution images of the biatrial geometry and the relative electrode positions. On the surface unipolar electrograms acquired during AF we developed specific signal-analysis process combining filtering, wavelet transform, and phase mapping. At least 5 windows with spontaneous, long ventricular pauses were selected for mapping. The incidence, location and characteristics of localized sources (foci and rotors) were assessed on the cumulative duration of all recorded windows.
In a patient with paroxysmal AF, noninvasive maps showed multiple single or repetitive discharges from 3 pulmonary veins (PVs), a rotor meandering along the right venous ostia, and their mutual interplay. All areas outside the left posterior wall were passively activated. AF terminated during isolation of right PV.
In a patient with persistent AF for 7 months, a rotor was identified recurrently, drifting in the left atrial inferior and posterior wall and in the roof. It was not stationary for more than 2 rotations. The right atrial free wall was activated over the Bachman's bundle by a passive wavefront propagating in a counterclockwise pattern. Ablation at the rotor locations abruptly converted AF into atrial tachycardia after 10 minutes of radiofrequency application. Further mapping and ablation confirmed a counterclockwise cavotricuspid isthmus—dependent flutter.
Conclusions
This report demonstrates the feasibility of noninvasive panoramic mapping of AF in identifying active sources, which include unstable rotors and PV foci, and its validation by ablation results.read more
Citations
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Journal ArticleDOI
Driver Domains in Persistent Atrial Fibrillation
Michel Haïssaguerre,Mélèze Hocini,Arnaud Denis,Ashok J. Shah,Yuki Komatsu,Seigo Yamashita,Matthew Daly,Sana Amraoui,Stephan Zellerhoff,Marie-Quitterie Picat,Adam Quotb,Laurence Jesel,Han S. Lim,Sylvain Ploux,Pierre Bordachar,Guillaume Attuel,Valentin Meillet,Philippe Ritter,Nicolas Derval,Frederic Sacher,Olivier Bernus,Hubert Cochet,Pierre Jaïs,Rémi Dubois +23 more
TL;DR: Persistent AF in early months is maintained predominantly by drivers clustered in a few regions, most of them being unstable reentries.
Journal ArticleDOI
Ablation of rotor and focal sources reduces late recurrence of atrial fibrillation compared with trigger ablation alone: extended follow-up of the CONFIRM trial (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation).
Sanjiv M. Narayan,Sanjiv M. Narayan,Tina Baykaner,Paul Clopton,Amir A. Schricker,Gautam G. Lalani,David E. Krummen,Kalyanam Shivkumar,John M. Miller +8 more
TL;DR: FIRM-guided ablation is more durable than conventional trigger-based ablation in preventing 3-year AF recurrence and future studies should investigate how ablation of patient-specific AF-sustaining rotors and focal sources alters the natural history of arrhythmia recurrence.
Journal ArticleDOI
The 'Digital Twin' to enable the vision of precision cardiology.
Jorge Corral-Acero,Francesca Margara,Maciej Marciniak,Cristobal Rodero,Filip Loncaric,Yingjing Feng,Andrew Gilbert,Joao Filipe Fernandes,Hassaan A. Bukhari,Ali Wajdan,Manuel Villegas Martinez,Mariana Sousa Santos,Mehrdad Shamohammdi,Hongxing Luo,Philip Westphal,Paul Leeson,Paolo DiAchille,Viatcheslav Gurev,Manuel Mayr,Liesbet Geris,Pras Pathmanathan,Tina M. Morrison,Richard Cornelussen,Frits W. Prinzen,Tammo Delhaas,Ada Doltra,Marta Sitges,Edward J. Vigmond,Ernesto Zacur,Vicente Grau,Blanca Rodriguez,Espen W. Remme,Steven A. Niederer,Peter Mortier,Kristin McLeod,Mark Potse,Esther Pueyo,Alfonso Bueno-Orovio,Pablo Lamata +38 more
TL;DR: It is argued that the second enabling pillar towards this vision is the increasing power of computers and algorithms to learn, reason, and build the ‘digital twin’ of a patient.
Journal ArticleDOI
Five-Year Outcome of Catheter Ablation of Persistent Atrial Fibrillation Using Termination of Atrial Fibrillation as a Procedural Endpoint
Daniel Scherr,Paul Khairy,Shinsuke Miyazaki,Valerie Aurillac-Lavignolle,Patrizio Pascale,Stephen B. Wilton,Khaled Ramoul,Yuki Komatsu,Laurent Roten,Amir Jadidi,Nick Linton,Michala Pedersen,Matthew Daly,Mark D O'Neill,Sébastien Knecht,Rukshen Weerasooriya,Thomas Rostock,Martin Manninger,Hubert Cochet,Ashok J. Shah,Sunthareth Yeim,Arnaud Denis,Nicolas Derval,Mélèze Hocini,Frederic Sacher,Michel Haïssaguerre,Pierre Jaïs +26 more
TL;DR: In patients with persistent AF, an ablation strategy aiming at AF termination is associated with freedom from arrhythmia recurrence in the majority of patients over a 5-year follow-up period.
Journal ArticleDOI
Patient-derived models link re-entrant driver localization in atrial fibrillation to fibrosis spatial pattern.
Sohail Zahid,Hubert Cochet,Hubert Cochet,Patrick M. Boyle,Erica L. Schwarz,Kaitlyn N. Whyte,Edward J. Vigmond,Rémi Dubois,Mélèze Hocini,Mélèze Hocini,Michel Haïssaguerre,Michel Haïssaguerre,Pierre Jaïs,Pierre Jaïs,Natalia A. Trayanova,Natalia A. Trayanova +15 more
TL;DR: Patient-derived models demonstrate that AF in fibrotic substrates is perpetuated by RDs persisting in fibrosis boundary zones characterized by specific regional fibrosis metrics (high FE and FD).
References
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Journal ArticleDOI
The surgical treatment of atrial fibrillation: III. Development of a definitive surgical procedure
James L. Cox,Richard B. Schuessler,Harry J. D'Agostino,Constance M. Stone,Byung Chul Chang,Michael E. Cain,Peter B. Corr,John P. Boineau +7 more
TL;DR: Since September 1987, this surgical procedure has been applied in seven patients and all seven patients have been cured of atrial fibrillation and none is receiving any postoperative antiarrhythmic medications.
Journal ArticleDOI
Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: A randomized controlled trial
David J. Wilber,Carlo Pappone,Petr Neuzil,Angelo Amato Vincenzo de Paola,Frank Marchlinski,Andrea Natale,Laurent Macle,Emile G. Daoud,Hugh Calkins,Burr Hall,Vivek Y. Reddy,Giuseppe Augello,Matthew R. Reynolds,Chandan Vinekar,Christine Y. Liu,Scott M. Berry,Donald A. Berry +16 more
TL;DR: Among patients with paroxysmal AF who had not responded to at least 1 antiarrhythmic drug, the use of catheter ablation compared with ADT resulted in a longer time to treatment failure during the 9-month follow-up period.
Journal ArticleDOI
High-density mapping of electrically induced atrial fibrillation in humans.
Karen T. S. Konings,Charles J. H. J. Kirchhof,Joep R. L. M. Smeets,Hein J.J. Wellens,Olaf C. Penn,Maurits A. Allessie +5 more
TL;DR: In this article, the authors reconstruct and classify the patterns of human right atrial (RA) activation during electrically induced atrial fibrillation (AF) in humans, based on multiple reentering wavelets.
Journal ArticleDOI
Spectral Analysis Identifies Sites of High-Frequency Activity Maintaining Atrial Fibrillation in Humans
Prashanthan Sanders,Omer Berenfeld,Mélèze Hocini,Pierre Jaïs,Ravi Vaidyanathan,Li Fern Hsu,S. Garrigue,Yoshihide Takahashi,Martin Rotter,Frédéric Sacher,C. Scavee,Robert Ploutz-Snyder,José Jalife,Michel Haïssaguerre +13 more
TL;DR: Spectral analysis and frequency mapping identify localized sites of high-frequency activity during atrial fibrillation in humans with different distributions in paroxysmal and permanent AF, indicating their role in the maintenance of AF.
Journal ArticleDOI
Catheter ablation of long-lasting persistent atrial fibrillation: critical structures for termination.
Michel Haïssaguerre,Prashanthan Sanders,Mélèze Hocini,Yoshihide Takahashi,Martin Rotter,Frederic Sacher,Thomas Rostock,Li-Fern Hsu,Pierre Bordachar,Sylvain Reuter,Raymond Roudaut,Jacques Clémenty,Pierre Jaïs +12 more
TL;DR: This poster focuses on the part of the atrial region that is involved in the beating of the heart and is known to have a role in the maintenance of persistent atrial fibrillation.
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