Epicardial wave mapping in human long-lasting persistent atrial fibrillation: Transient rotational circuits, complex wavefronts, and disorganized activity

Geoffrey Lee, Saurabh Kumar, Andrew Teh, Andrew Madry, Steven Spence, Marco Larobina, John Goldblatt, Robin Brown, Victoria Atkinson, Simon Moten, Joseph B. Morton, Prashanthan Sanders, Peter M. Kistler, Jonathan M. Kalman

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

Objectives To characterize the nature of atrial fibrillation (AF) activation in human persistent AF (PerAF) using modern tools including activation, directionality analyses, complex-fractionated electrogram, and spectral information.BackgroundThe mechanism of PerAF in humans is uncertain.Methods and resultsHigh-density epicardial mapping (128 electrodes/6.75 cm2) of the posterior LA wall (PLAW), LA and RA appendage (LAA, RAA), and RSPV-LA junction was performed in 18 patients with PerAF undergoing open heart surgery. Continuous 10 s recordings were analysed offline. Activation patterns were characterized into four subtypes (i) wavefronts (broad or multiple), (ii) rotational circuits (≥2 rotations of 360), (iii) focal sources with centrifugal activation of the entire mapping area, or (iv) disorganized activity [isolated chaotic activation(s) that propagate ≤3 bipoles or activation(s) that occur as isolated beats dissociated from the activation of adjacent bipole sites].Activation at a total of 36 regions were analysed (14 PLAW, 3 RSPV-LA, 12 LAA, and 7 RAA) creating a database of 2904 activation patterns. In the majority of maps, activation patterns were highly heterogeneous with multiple unstable activation patterns transitioning from one to another during each recording. A mean of 3.8 ± 1.6 activation subtypes was seen per map. The most common patterns seen were multiple wavefronts (56.2 ± 32%) and disorganized activity (24.2 ± 30.3%). Only 2 of 36 maps (5.5%) showed a single stable activation pattern throughout the 10-s period. These were stable planar wavefronts. Three transient rotational circuits were observed. Two of the transient circuits were located in the posterior left atrium, while the third was located on the anterior surface of the LAA. Focal activations accounted for 11.3 ± 14.2% of activations and were all short-lived (≤2 beats), with no site demonstrating sustained focal activity.ConclusionHuman long-lasting PerAF is characterized by heterogeneous and unstable patterns of activation including wavefronts, transient rotational circuits, and disorganized activity.

LanguageEnglish
Pages86-97
Number of pages12
JournalEuropean Heart Journal
Volume35
Issue number2
DOIs
Publication statusPublished - 24 Jan 2014

Keywords

  • Atrial fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lee, Geoffrey ; Kumar, Saurabh ; Teh, Andrew ; Madry, Andrew ; Spence, Steven ; Larobina, Marco ; Goldblatt, John ; Brown, Robin ; Atkinson, Victoria ; Moten, Simon ; Morton, Joseph B. ; Sanders, Prashanthan ; Kistler, Peter M. ; Kalman, Jonathan M. / Epicardial wave mapping in human long-lasting persistent atrial fibrillation : Transient rotational circuits, complex wavefronts, and disorganized activity. In: European Heart Journal. 2014 ; Vol. 35, No. 2. pp. 86-97.
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title = "Epicardial wave mapping in human long-lasting persistent atrial fibrillation: Transient rotational circuits, complex wavefronts, and disorganized activity",
abstract = "Objectives To characterize the nature of atrial fibrillation (AF) activation in human persistent AF (PerAF) using modern tools including activation, directionality analyses, complex-fractionated electrogram, and spectral information.BackgroundThe mechanism of PerAF in humans is uncertain.Methods and resultsHigh-density epicardial mapping (128 electrodes/6.75 cm2) of the posterior LA wall (PLAW), LA and RA appendage (LAA, RAA), and RSPV-LA junction was performed in 18 patients with PerAF undergoing open heart surgery. Continuous 10 s recordings were analysed offline. Activation patterns were characterized into four subtypes (i) wavefronts (broad or multiple), (ii) rotational circuits (≥2 rotations of 360), (iii) focal sources with centrifugal activation of the entire mapping area, or (iv) disorganized activity [isolated chaotic activation(s) that propagate ≤3 bipoles or activation(s) that occur as isolated beats dissociated from the activation of adjacent bipole sites].Activation at a total of 36 regions were analysed (14 PLAW, 3 RSPV-LA, 12 LAA, and 7 RAA) creating a database of 2904 activation patterns. In the majority of maps, activation patterns were highly heterogeneous with multiple unstable activation patterns transitioning from one to another during each recording. A mean of 3.8 ± 1.6 activation subtypes was seen per map. The most common patterns seen were multiple wavefronts (56.2 ± 32{\%}) and disorganized activity (24.2 ± 30.3{\%}). Only 2 of 36 maps (5.5{\%}) showed a single stable activation pattern throughout the 10-s period. These were stable planar wavefronts. Three transient rotational circuits were observed. Two of the transient circuits were located in the posterior left atrium, while the third was located on the anterior surface of the LAA. Focal activations accounted for 11.3 ± 14.2{\%} of activations and were all short-lived (≤2 beats), with no site demonstrating sustained focal activity.ConclusionHuman long-lasting PerAF is characterized by heterogeneous and unstable patterns of activation including wavefronts, transient rotational circuits, and disorganized activity.",
keywords = "Atrial fibrillation",
author = "Geoffrey Lee and Saurabh Kumar and Andrew Teh and Andrew Madry and Steven Spence and Marco Larobina and John Goldblatt and Robin Brown and Victoria Atkinson and Simon Moten and Morton, {Joseph B.} and Prashanthan Sanders and Kistler, {Peter M.} and Kalman, {Jonathan M.}",
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Lee, G, Kumar, S, Teh, A, Madry, A, Spence, S, Larobina, M, Goldblatt, J, Brown, R, Atkinson, V, Moten, S, Morton, JB, Sanders, P, Kistler, PM & Kalman, JM 2014, 'Epicardial wave mapping in human long-lasting persistent atrial fibrillation: Transient rotational circuits, complex wavefronts, and disorganized activity', European Heart Journal, vol. 35, no. 2, pp. 86-97. https://doi.org/10.1093/eurheartj/eht267

Epicardial wave mapping in human long-lasting persistent atrial fibrillation : Transient rotational circuits, complex wavefronts, and disorganized activity. / Lee, Geoffrey; Kumar, Saurabh; Teh, Andrew; Madry, Andrew; Spence, Steven; Larobina, Marco; Goldblatt, John; Brown, Robin; Atkinson, Victoria; Moten, Simon; Morton, Joseph B.; Sanders, Prashanthan; Kistler, Peter M.; Kalman, Jonathan M.

In: European Heart Journal, Vol. 35, No. 2, 24.01.2014, p. 86-97.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Epicardial wave mapping in human long-lasting persistent atrial fibrillation

T2 - European heart journal

AU - Lee, Geoffrey

AU - Kumar, Saurabh

AU - Teh, Andrew

AU - Madry, Andrew

AU - Spence, Steven

AU - Larobina, Marco

AU - Goldblatt, John

AU - Brown, Robin

AU - Atkinson, Victoria

AU - Moten, Simon

AU - Morton, Joseph B.

AU - Sanders, Prashanthan

AU - Kistler, Peter M.

AU - Kalman, Jonathan M.

PY - 2014/1/24

Y1 - 2014/1/24

N2 - Objectives To characterize the nature of atrial fibrillation (AF) activation in human persistent AF (PerAF) using modern tools including activation, directionality analyses, complex-fractionated electrogram, and spectral information.BackgroundThe mechanism of PerAF in humans is uncertain.Methods and resultsHigh-density epicardial mapping (128 electrodes/6.75 cm2) of the posterior LA wall (PLAW), LA and RA appendage (LAA, RAA), and RSPV-LA junction was performed in 18 patients with PerAF undergoing open heart surgery. Continuous 10 s recordings were analysed offline. Activation patterns were characterized into four subtypes (i) wavefronts (broad or multiple), (ii) rotational circuits (≥2 rotations of 360), (iii) focal sources with centrifugal activation of the entire mapping area, or (iv) disorganized activity [isolated chaotic activation(s) that propagate ≤3 bipoles or activation(s) that occur as isolated beats dissociated from the activation of adjacent bipole sites].Activation at a total of 36 regions were analysed (14 PLAW, 3 RSPV-LA, 12 LAA, and 7 RAA) creating a database of 2904 activation patterns. In the majority of maps, activation patterns were highly heterogeneous with multiple unstable activation patterns transitioning from one to another during each recording. A mean of 3.8 ± 1.6 activation subtypes was seen per map. The most common patterns seen were multiple wavefronts (56.2 ± 32%) and disorganized activity (24.2 ± 30.3%). Only 2 of 36 maps (5.5%) showed a single stable activation pattern throughout the 10-s period. These were stable planar wavefronts. Three transient rotational circuits were observed. Two of the transient circuits were located in the posterior left atrium, while the third was located on the anterior surface of the LAA. Focal activations accounted for 11.3 ± 14.2% of activations and were all short-lived (≤2 beats), with no site demonstrating sustained focal activity.ConclusionHuman long-lasting PerAF is characterized by heterogeneous and unstable patterns of activation including wavefronts, transient rotational circuits, and disorganized activity.

AB - Objectives To characterize the nature of atrial fibrillation (AF) activation in human persistent AF (PerAF) using modern tools including activation, directionality analyses, complex-fractionated electrogram, and spectral information.BackgroundThe mechanism of PerAF in humans is uncertain.Methods and resultsHigh-density epicardial mapping (128 electrodes/6.75 cm2) of the posterior LA wall (PLAW), LA and RA appendage (LAA, RAA), and RSPV-LA junction was performed in 18 patients with PerAF undergoing open heart surgery. Continuous 10 s recordings were analysed offline. Activation patterns were characterized into four subtypes (i) wavefronts (broad or multiple), (ii) rotational circuits (≥2 rotations of 360), (iii) focal sources with centrifugal activation of the entire mapping area, or (iv) disorganized activity [isolated chaotic activation(s) that propagate ≤3 bipoles or activation(s) that occur as isolated beats dissociated from the activation of adjacent bipole sites].Activation at a total of 36 regions were analysed (14 PLAW, 3 RSPV-LA, 12 LAA, and 7 RAA) creating a database of 2904 activation patterns. In the majority of maps, activation patterns were highly heterogeneous with multiple unstable activation patterns transitioning from one to another during each recording. A mean of 3.8 ± 1.6 activation subtypes was seen per map. The most common patterns seen were multiple wavefronts (56.2 ± 32%) and disorganized activity (24.2 ± 30.3%). Only 2 of 36 maps (5.5%) showed a single stable activation pattern throughout the 10-s period. These were stable planar wavefronts. Three transient rotational circuits were observed. Two of the transient circuits were located in the posterior left atrium, while the third was located on the anterior surface of the LAA. Focal activations accounted for 11.3 ± 14.2% of activations and were all short-lived (≤2 beats), with no site demonstrating sustained focal activity.ConclusionHuman long-lasting PerAF is characterized by heterogeneous and unstable patterns of activation including wavefronts, transient rotational circuits, and disorganized activity.

KW - Atrial fibrillation

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U2 - 10.1093/eurheartj/eht267

DO - 10.1093/eurheartj/eht267

M3 - Article

VL - 35

SP - 86

EP - 97

JO - European heart journal

JF - European heart journal

SN - 0195-668X

IS - 2

ER -