Wavefront Field Mapping Reveals a Physiologic Network Between Drivers Where Ablation Terminates Atrial Fibrillation

George Leef, Fatemah Shenasa, Neal K. Bhatia, Albert J. Rogers, William Sauer, John Miller, Mark Swerdlow, Mallika Tamboli, Mahmood I. Alhusseini, Erin Armenia, Tina Baykaner, Johannes Brachmann, Mintu P. Turakhia, Felipe Atienza, Wouter Jan Rappel, Paul J. Wang, Sanjiv M. Narayan

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Localized drivers are proposed mechanisms for persistent atrial fibrillation (AF) from optical mapping of human atria and clinical studies of AF, yet are controversial because drivers fluctuate and ablating them may not terminate AF. We used wavefront field mapping to test the hypothesis that AF drivers, if concurrent, may interact to produce fluctuating areas of control to explain their appearance/disappearance and acute impact of ablation. METHODS: We recruited 54 patients from an international registry in whom persistent AF terminated by targeted ablation. Unipolar AF electrograms were analyzed from 64-pole baskets to reconstruct activation times, map propagation vectors each 20 ms, and create nonproprietary phase maps. RESULTS: Each patient (63.6±8.5 years, 29.6% women) showed 4.0±2.1 spatially anchored rotational or focal sites in AF in 3 patterns. First, a single (type I; n=7) or, second, paired chiral-antichiral (type II; n=5) rotational drivers controlled most of the atrial area. Ablation of 1 to 2 large drivers terminated all cases of types I or II AF. Third, interaction of 3 to 5 drivers (type III; n=42) with changing areas of control. Targeted ablation at driver centers terminated AF and required more ablation in types III versus I (P=0.02 in left atrium). CONCLUSIONS: Wavefront field mapping of persistent AF reveals a pathophysiologic network of a small number of spatially anchored rotational and focal sites, which interact, fluctuate, and control varying areas. Future work should define whether AF drivers that control larger atrial areas are attractive targets for ablation.

Original languageEnglish (US)
Pages (from-to)e006835
JournalCirculation. Arrhythmia and electrophysiology
Volume12
Issue number8
DOIs
StatePublished - Aug 1 2019

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Pulmonary Veins
Atrial Fibrillation
Registries
Recurrence
Cardiac Electrophysiologic Techniques
Heart Atria

Keywords

  • atrial fibrillation
  • organizations
  • pulmonary veins
  • recurrence
  • registries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Wavefront Field Mapping Reveals a Physiologic Network Between Drivers Where Ablation Terminates Atrial Fibrillation. / Leef, George; Shenasa, Fatemah; Bhatia, Neal K.; Rogers, Albert J.; Sauer, William; Miller, John; Swerdlow, Mark; Tamboli, Mallika; Alhusseini, Mahmood I.; Armenia, Erin; Baykaner, Tina; Brachmann, Johannes; Turakhia, Mintu P.; Atienza, Felipe; Rappel, Wouter Jan; Wang, Paul J.; Narayan, Sanjiv M.

In: Circulation. Arrhythmia and electrophysiology, Vol. 12, No. 8, 01.08.2019, p. e006835.

Research output: Contribution to journalArticle

Leef, G, Shenasa, F, Bhatia, NK, Rogers, AJ, Sauer, W, Miller, J, Swerdlow, M, Tamboli, M, Alhusseini, MI, Armenia, E, Baykaner, T, Brachmann, J, Turakhia, MP, Atienza, F, Rappel, WJ, Wang, PJ & Narayan, SM 2019, 'Wavefront Field Mapping Reveals a Physiologic Network Between Drivers Where Ablation Terminates Atrial Fibrillation', Circulation. Arrhythmia and electrophysiology, vol. 12, no. 8, pp. e006835. https://doi.org/10.1161/CIRCEP.118.006835
Leef, George ; Shenasa, Fatemah ; Bhatia, Neal K. ; Rogers, Albert J. ; Sauer, William ; Miller, John ; Swerdlow, Mark ; Tamboli, Mallika ; Alhusseini, Mahmood I. ; Armenia, Erin ; Baykaner, Tina ; Brachmann, Johannes ; Turakhia, Mintu P. ; Atienza, Felipe ; Rappel, Wouter Jan ; Wang, Paul J. ; Narayan, Sanjiv M. / Wavefront Field Mapping Reveals a Physiologic Network Between Drivers Where Ablation Terminates Atrial Fibrillation. In: Circulation. Arrhythmia and electrophysiology. 2019 ; Vol. 12, No. 8. pp. e006835.
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AU - Shenasa, Fatemah

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AU - Rogers, Albert J.

AU - Sauer, William

AU - Miller, John

AU - Swerdlow, Mark

AU - Tamboli, Mallika

AU - Alhusseini, Mahmood I.

AU - Armenia, Erin

AU - Baykaner, Tina

AU - Brachmann, Johannes

AU - Turakhia, Mintu P.

AU - Atienza, Felipe

AU - Rappel, Wouter Jan

AU - Wang, Paul J.

AU - Narayan, Sanjiv M.

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N2 - BACKGROUND: Localized drivers are proposed mechanisms for persistent atrial fibrillation (AF) from optical mapping of human atria and clinical studies of AF, yet are controversial because drivers fluctuate and ablating them may not terminate AF. We used wavefront field mapping to test the hypothesis that AF drivers, if concurrent, may interact to produce fluctuating areas of control to explain their appearance/disappearance and acute impact of ablation. METHODS: We recruited 54 patients from an international registry in whom persistent AF terminated by targeted ablation. Unipolar AF electrograms were analyzed from 64-pole baskets to reconstruct activation times, map propagation vectors each 20 ms, and create nonproprietary phase maps. RESULTS: Each patient (63.6±8.5 years, 29.6% women) showed 4.0±2.1 spatially anchored rotational or focal sites in AF in 3 patterns. First, a single (type I; n=7) or, second, paired chiral-antichiral (type II; n=5) rotational drivers controlled most of the atrial area. Ablation of 1 to 2 large drivers terminated all cases of types I or II AF. Third, interaction of 3 to 5 drivers (type III; n=42) with changing areas of control. Targeted ablation at driver centers terminated AF and required more ablation in types III versus I (P=0.02 in left atrium). CONCLUSIONS: Wavefront field mapping of persistent AF reveals a pathophysiologic network of a small number of spatially anchored rotational and focal sites, which interact, fluctuate, and control varying areas. Future work should define whether AF drivers that control larger atrial areas are attractive targets for ablation.

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