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Spatial Relation Between Left Atrial Anatomical Contact Areas and Circular Activation in Persistent Atrial Fibrillation.
- Source :
-
Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2016 May; Vol. 27 (5), pp. 515-23. Date of Electronic Publication: 2016 Feb 04. - Publication Year :
- 2016
-
Abstract
- Introduction: Atrial low-voltage zones (LVZs) may be related to maintenance of atrial fibrillation (AF). The influence of left atrial (LA) contact areas (CoAs) on reentrant or rotor-like sources maintaining AF has not been investigated.<br />Methods and Results: Forty patients with persistent AF (PsAF) were analyzed. Three representative CoA regions in the LA (ascending aorta: anterior wall; descending aorta: left inferior pulmonary vein; and vertebrae: posterior wall) were visualized by enhanced CT. Using circular catheters, the LVZs (<0.5 mV) were assessed after restoration of SR, and local activation mapping and frequency domain analyses were performed after induction of AF. Circular activation during AF was visually defined as sites with ≥2 rotations by serial electrograms encompassing >80% of the mean AF cycle length. A pivot was defined as the core of the localized circular activation. Anterior (39/40 patients, 98%), left pulmonary vein antrum (27/40, 68%), and posterior (19/40, 48%) CoAs were identified, and 80% (68/85) of those sites were overlapped by or close (<3 mm) to LVZs. Thirty-six (90%) patients demonstrated circular activation (3.1±1.7 sites/patients) along with significantly higher organized dominant frequencies (6.3 ± 0.5 Hz, regularity-index: 0.26 [0.23-0.41]) within the LA, and the average electrogram amplitude of those pivots was 0.30 mV (0.18-0.52). Of those sites, 55% (66/120) were located at or close to CoA regions. Catheter ablation including of LVZs neighboring CoAs terminated AF in 9 (23%) patients.<br />Conclusions: External anatomical structures contacting the LA may be related to unique conduction properties in diseased myocardium necessary for PsAF maintenance.<br /> (© 2016 Wiley Periodicals, Inc.)
- Subjects :
- Action Potentials
Aged
Atrial Fibrillation diagnosis
Atrial Fibrillation surgery
Catheter Ablation
Electrophysiologic Techniques, Cardiac
Female
Heart Atria diagnostic imaging
Heart Atria surgery
Heart Conduction System diagnostic imaging
Heart Conduction System surgery
Heart Rate
Humans
Male
Middle Aged
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome
Atrial Fibrillation physiopathology
Atrial Function, Left
Heart Atria physiopathology
Heart Conduction System physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1540-8167
- Volume :
- 27
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of cardiovascular electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 26725874
- Full Text :
- https://doi.org/10.1111/jce.12907