Interaction of Localized Drivers and Disorganized Activation in Persistent Atrial Fibrillation: Reconciling Putative Mechanisms Using Multiple Mapping Techniques

Christopher A.B. Kowalewski, Fatemah Shenasa, Miguel Rodrigo, Paul Clopton, Gabriela Meckler, Mahmood I. Alhusseini, Mark A. Swerdlow, Vijay Joshi, Samir Hossainy, Junaid A.B. Zaman, Tina Baykaner, Albert J. Rogers, Johannes Brachmann, John M. Miller, David E. Krummen, William H. Sauer, Nicholas S. Peters, Paul J. Wang, Sanjiv M. Narayan

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Background: Mechanisms for persistent atrial fibrillation (AF) are unclear. We hypothesized that putative AF drivers and disorganized zones may interact dynamically over short time scales. We studied this interaction over prolonged durations, focusing on regions where ablation terminates persistent AF using 2 mapping methods. Methods: We recruited 55 patients with persistent AF in whom ablation terminated AF prior to pulmonary vein isolation from a multicenter registry. AF was mapped globally using electrograms for 360±45 cycles using (1) a published phase method and (2) a commercial activation/phase method. Results: Patients were 62.2±9.7 years, 76% male. Sites of AF termination showed rotational/focal patterns by methods 1 and 2 (51/55 vs 55/55; P=0.13) in spatially conserved regions, yet fluctuated over time. Time points with no AF driver showed competing drivers elsewhere or disordered waves. Organized regions were detected for 61.6±23.9% and 70.6±20.6% of 1 minute per method (P=nonsignificant), confirmed by automatic phase tracking (P<0.05). To detect AF drivers with >90% sensitivity, 8 to 32 s of AF recordings were required depending on driver definition. Conclusions: Sites at which persistent AF terminated by ablation show organized activation that fluctuate over time, because of collision from concurrent organized zones or fibrillatory waves, yet recur in conserved spatial regions. Results were similar by 2 mapping methods. This network of competing mechanisms should be reconciled with existing disorganized or driver mechanisms for AF, to improve clinical mapping and ablation of persistent AF.

Original languageEnglish (US)
Article numbere005846
JournalCirculation: Arrhythmia and Electrophysiology
Volume11
Issue number6
DOIs
StatePublished - Jun 1 2018

Keywords

  • atrial fibrillation
  • mapping
  • network
  • patients
  • pulmonary vein
  • registries
  • tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Kowalewski, C. A. B., Shenasa, F., Rodrigo, M., Clopton, P., Meckler, G., Alhusseini, M. I., Swerdlow, M. A., Joshi, V., Hossainy, S., Zaman, J. A. B., Baykaner, T., Rogers, A. J., Brachmann, J., Miller, J. M., Krummen, D. E., Sauer, W. H., Peters, N. S., Wang, P. J., & Narayan, S. M. (2018). Interaction of Localized Drivers and Disorganized Activation in Persistent Atrial Fibrillation: Reconciling Putative Mechanisms Using Multiple Mapping Techniques. Circulation: Arrhythmia and Electrophysiology, 11(6), [e005846]. https://doi.org/10.1161/CIRCEP.117.005846