1. Slow Conduction Corridors and Pivot Sites Characterize the Electrical Remodeling in Atrial Fibrillation.
- Author
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Frontera A, Pagani S, Limite LR, Peirone A, Fioravanti F, Enache B, Cuellar Silva J, Vlachos K, Meyer C, Montesano G, Manzoni A, Dedé L, Quarteroni A, Lațcu DG, Rossi P, and Della Bella P
- Subjects
- Heart Atria, Humans, Atrial Fibrillation surgery, Atrial Remodeling, Catheter Ablation, Pulmonary Veins surgery
- Abstract
Objectives: This study aimed to evaluate the progression of electrophysiological phenomena in a cohort of patients with paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PsAF)., Background: Electrical remodeling has been conjectured to determine atrial fibrillation (AF) progression., Methods: High-density electroanatomic maps during sinus rhythm of 20 patients with AF (10 PAF, 10 PsAF) were compared with 5 healthy control subjects (subjects undergoing ablation of a left-sided accessory pathway). A computational postprocessing of electroanatomic maps was performed to identify specific electrophysiological phenomena: slow conductions corridors, defined as discrete areas of conduction velocity <50 cm/s, and pivot points, defined as sites showing high wave-front curvature documented by a curl module >2.5 1/s., Results: A progressive decrease of mean conduction velocity was recorded across the groups (111.6 ± 55.5 cm/s control subjects, 97.1 ± 56.3 cm/s PAF, and 84.7 ± 55.7 cm/s PsAF). The number and density of slow conduction corridors increase in parallel with the progression of AF (8.6 ± 2.2 control subjects, 13.3 ± 3.2 PAF, and 20.5 ± 4.5 PsAF). In PsAF the atrial substrate is characterized by a higher curvature of wave-front propagation (0.86 ± 0.71 1/s PsAF vs 0.74 ± 0.63 1/s PAF; P = 0.003) and higher number of pivot points (25.1 ± 13.8 PsAF vs 9.5 ± 6.7 PAF; P < 0.0001). Slow conductions: corridors were mostly associated with pivot sites tending to cluster around pulmonary veins antra., Conclusions: The electrical remodeling hinges mainly on corridors of slow conduction and higher curvature of wave-front propagation. Pivot points associated to SC corridors may be the major determinants for functional localized re-entrant circuits creating the substrate for maintenance of AF., Competing Interests: Funding Support and Author Disclosures Drs Della Bella and Frontera have received consultant fees from Abbott, Biosense Webster, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
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