Document Detail

Localized sources maintaining atrial fibrillation organized by prior ablation.
MedLine Citation:
PMID:  16461833     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Endocardial mapping of localized sources driving atrial fibrillation (AF) in humans has not been reported. METHODS AND RESULTS: Fifty patients with AF organized by prior pulmonary vein and linear ablation were studied. AF was considered organized if mapping during AF showed irregular but discrete atrial complexes exhibiting consistent activation sequences for >75% of the time using a 20-pole catheter with 5 radiating spines covering 3.5-cm diameter or sequential conventional mapping. A site or region centrifugally activating the remaining atrial tissue defined a source. During AF with a cycle length of 211+/-32 ms, activation mapping identified 1 to 3 sources at the origin of atrial wavefronts in 38 patients (76%) predominantly in the left atrium, including the coronary sinus region. Electrograms at the earliest area varied from discrete centrifugal activation to an activity spanning 75% to 100% of the cycle length in 42% of cases, the latter indicating complex local conduction or a reentrant circuit. A gradient of cycle length (>20 ms) to the surrounding atrium was observed in 28%. Local radiofrequency ablation prolonged AF cycle length by 28+/-22 ms and either terminated AF or changed activation sequence to another organized rhythm. In 4 patients, the driving source was isolated, surrounded by the atrium in sinus rhythm, and still firing at high frequency (228+/-31 ms) either permanently or in bursts. CONCLUSIONS: AF associated with consistent atrial activation sequences after prior ablation emanates mostly from localized sources that can be mapped and ablated. Some sources harbor electrograms suggesting the presence of localized reentry.
Michel Haïssaguerre; Mélèze Hocini; Prashanthan Sanders; Yoshihide Takahashi; Martin Rotter; Frederic Sacher; Thomas Rostock; Li-Fern Hsu; Anders Jonsson; Mark D O'Neill; Pierre Bordachar; Sylvain Reuter; Raymond Roudaut; Jacques Clémenty; Pierre Jaïs
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  113     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-02-07     Completed Date:  2006-03-10     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  616-25     Citation Subset:  AIM; IM    
Hôpital Cardiologique du Haut-Lévêque, University Victor Segalen, Bordeaux, France.
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MeSH Terms
Amiodarone / pharmacology
Arrhythmias, Cardiac / physiopathology,  therapy
Atrial Fibrillation / physiopathology*,  therapy*
Body Surface Potential Mapping*
Catheter Ablation*
Middle Aged
Pulmonary Veins
Reg. No./Substance:

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