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Human Atrial Fibrillation Initiates Via Organized Rather Than Disorganized Mechanisms.
MedLine Citation:
PMID:  25217042     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: -It is unknown how atrial fibrillation (AF) is actually initiated by triggers. Based on consistencies in atrial structure and function in individual patients between episodes of AF, we hypothesized that human AF initiates when triggers interact with deterministic properties of the atria and may engage organized mechanisms.
METHODS AND RESULTS: -In 31 AF patients we mapped AF initiation after spontaneous triggers or programmed stimulation. We used 64-pole basket catheters to measure regional dynamic conduction slowing and to create bi-atrial activation maps during transitions to AF. Sixty-two AF initiations were recorded (spontaneous, n=28; induced, n=34). Notably, AF did not initiate by disorganized mechanisms, but by either a dominant reentrant spiral wave (76%) or a repetitive focal driver. Both mechanisms were located 21±17mm from their triggers. AF-initiating spirals formed at the site showing the greatest rate-dependent slowing in each patient. Accordingly, in 10/12 patients with multiple observed AF episodes, AF initiated using spatially conserved mechanisms despite diverse triggers.
CONCLUSIONS: -Human AF initiates from triggers by organized rather than disorganized mechanisms, either via spiral wave reentry at sites of dynamic conduction slowing, or via repetitive focal drivers. The finding that diverse triggers initiate AF at predictable, spatially conserved functional sites in each individual provides a novel deterministic paradigm for AF with therapeutic implications.
Authors:
Amir A Schricker; Gautam G Lalani; David E Krummen; Wouter-Jan Rappel; Sanjiv M Narayan
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-9-12
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  -     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2014 Sep 
Date Detail:
Created Date:  2014-9-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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