Journal ArticleDOI
Regional endocardial mapping of spontaneous and induced atrial fibrillation in patients with heart disease and refractory atrial fibrillation.
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TLDR
It is concluded that spontaneous AF is initiated by APCs arising in different right or left atrial regions in patients with structural heart disease and the initial region of atrial activation in AF is in proximity to the region of APC origin.Abstract:
We performed simultaneous catheter mapping of right and left atrial regions at onset and during sustenance of spontaneous atrial fibrillation (AF) in patients with ischemic and/or hypertensive heart disease. Seventeen patients with structural heart disease had spontaneous and electrically induced AF episodes mapped from their onset simultaneously in multiple right and left atrial regions. Atrial premature complexes (APCs) that initiated spontaneous AF had coupling intervals ranging from 260 to 400 ms (mean 332 ± 61), most commonly arising from the lateral right atrium (31%), right atrioventricular junction (13%), atrial septum (6%), superior left atrium (25%), or inferior left atrium (25%). APC morphology on surface electrocardiograms did not correlate with origin in specific atrial regions. The earliest regions of atrial activation for the first AF cycle were the lateral right atrium (n = 5), superior left atrium (n = 4), distal or mid coronary sinus (n = 4), atrial septum (n = 2), and right atrioventricular junction at the His bundle location (n = 2). Spontaneous AF at onset usually showed discrete but irregular electrograms at virtually all right and left atrial sites mapped, with a reproducible region of AF initiation in all 8 patients with multiple events. The region of earliest atrial activation at spontaneous AF onset was in close proximity to the APC origin in 15 of 16 patients (94%), and 39 of 40 episodes (97%) mapped. Stable patterns of right and left atrial activation were observed at AF onset in 14 patients. Induced AF elicited with right atrial stimulation demonstrated different sites of earliest regional atrial activation at onset compared with spontaneous AF events in 4 of 8 patients. However, discrete intracardiac electrograms were also present in induced AF in all of the mapped atrial regions. Furthermore, the site of extrastimulus delivery in induced AF was also found to be in close proximity to the earliest region of atrial activation for the first AF beat. We conclude that spontaneous AF is initiated by APCs arising in different right or left atrial regions in patients with structural heart disease and the initial region of atrial activation in AF is in proximity to the region of APC origin. Organized and repetitive electrical activation is frequently observed in both right and left atria at AF onset. Although electrically induced AF may have different activation patterns than spontaneous AF at onset in many patients, both types of AF demonstrate organization and earliest atrial activation in proximity to the initiating APC.read more
Citations
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Journal ArticleDOI
Biatrial multisite mapping of atrial premature complexes triggering onset of atrial fibrillation.
Claus Schmitt,Gjin Ndrepepa,Stefan Weber,Sebastian Schmieder,Sonja Weyerbrock,Michael Schneider,Martin R. Karch,Isabel Deisenhofer,Jürgen Schreieck,Bernhard Zrenner,Albert Schömig +10 more
TL;DR: It was shown that 47% of ectopic foci triggering the onset of AF were located outside the pulmonary veins in extravenous parts of the left atrium and the right atrium, and 27% of patients had AF onsets of bifocal origin, challenging the current opinion that extrapulmonary foci play a minor role in inducing AF.
Patent
System and method for targeting heart rhythm disorders using shaped ablation
TL;DR: In this paper, a system and method to target a biological rhythm disorder such as a heart rhythm disorder was proposed, where a computing device was used to determine a shape in a region of tissue defined by a source associated with the biological rhythm disorders that migrates spatially on or within the shape, and identifying at least one portion of the tissue proximate to the shape to enable selective modification of the at least part of tissue in order to terminate or alter the heart rhythm disorders.
Journal ArticleDOI
Clinical value of fibrillatory wave amplitude on surface ECG in patients with persistent atrial fibrillation.
Isabelle Nault,Nicolas Lellouche,Seiichiro Matsuo,Sébastien Knecht,Matthew Wright,Kang-Teng Lim,Frederic Sacher,Pyotr G. Platonov,Antoine Deplagne,Pierre Bordachar,Nicolas Derval,Mark D O'Neill,George J. Klein,Mélèze Hocini,Pierre Jaïs,Jacques Clémenty,Michel Haïssaguerre +16 more
TL;DR: Longer AF duration, older age and larger LA size are associated with fine AF amplitude, which predicts procedural termination of arrhyhmia in patients with persistent AF and freedom from AF upon follow-up.
Journal ArticleDOI
Morphological characteristics of P waves during selective pulmonary vein pacing.
Teiichi Yamane,Dipen Shah,Jing-Tian Peng,Pierre Jaïs,Mélèze Hocini,Isabel Deisenhofer,Kee-Joon Choi,Laurent Macle,Jacques Clémenty,Michel Haïssaguerre +9 more
TL;DR: Pacing from the different PVs produced a P-wave with distinctive characteristics that could be used as criteria in an algorithm to identify the PV of origin with an accuracy of 79%.
Journal ArticleDOI
Biatrial and three-dimensional mapping of spontaneous atrial arrhythmias in patients with refractory atrial fibrillation.
TL;DR: This work hypothesized that simultaneous biatrial and three‐dimensional noncontact mapping (NCM) would provide novel information on triggers, initiation, and evolution of spontaneous AF and permit study of different AF populations.
References
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Journal ArticleDOI
Atrial Fibrillation Begets Atrial Fibrillation A Study in Awake Chronically Instrumented Goats
TL;DR: Artificial maintenance of AF leads to a marked shortening of AERP, a reversion of its physiological rate adaptation, and an increase in rate, inducibility and stability of AF.
Journal ArticleDOI
A Focal Source of Atrial Fibrillation Treated by Discrete Radiofrequency Ablation
Pierre Jaïs,Michel Haïssaguerre,D. C. Shah,Salah Chouairi,L Gencel,Mélèze Hocini,Jacques Clementy +6 more
TL;DR: In some patients, the surface ECG pattern of atrial fibrillation is due to a focal rapidly firing source of activity that can be eliminated by discrete radiofrequency energy applications.
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.