Document Detail


Noninvasive characterization of epicardial activation in humans with diverse atrial fibrillation patterns.
MedLine Citation:
PMID:  20855661     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Various mechanisms of atrial fibrillation (AF) have been demonstrated experimentally. Invasive methods to study these mechanisms in humans have limitations, precluding continuous mapping of both atria with sufficient resolution. In this article, we present continuous biatrial epicardial activation sequences of AF in humans using noninvasive electrocardiographic imaging (ECGI).
METHODS AND RESULTS: In the testing phase, ECGI accuracy was evaluated by comparing ECGI with co-registered CARTO images during atrial pacing in 6 patients. Additionally, correlative observations from catheter mapping and ablation were compared with ECGI in 3 patients. In the study phase, ECGI maps during AF in 26 patients were analyzed for mechanisms and complexity. ECGI noninvasively imaged the low-amplitude signals of AF in a wide range of patients (97 procedural success). Spatial accuracy for determining initiation sites from pacing was 6 mm. Locations critical to maintenance of AF identified during catheter ablation were identified by ECGI; ablation near these sites restored sinus rhythm. In the study phase, the most common patterns of AF were multiple wavelets (92), with pulmonary vein (69) and non-pulmonary vein (62) focal sites. Rotor activity was seen rarely (15). AF complexity increased with longer clinical history of AF, although the degree of complexity of nonparoxysmal AF varied widely.
CONCLUSIONS: ECGI offers a noninvasive way to map epicardial activation patterns of AF in a patient-specific manner. The results highlight the coexistence of a variety of mechanisms and variable complexity among patients. Overall, complexity generally increased with duration of AF.
Authors:
Phillip S Cuculich; Yong Wang; Bruce D Lindsay; Mitchell N Faddis; Richard B Schuessler; Ralph J Damiano; Li Li; Yoram Rudy
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-09-20
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-05     Completed Date:  2010-10-29     Revised Date:  2014-08-20    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1364-72     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Age of Onset
Aged
Atrial Fibrillation / classification,  physiopathology*,  radiography,  surgery
Body Surface Potential Mapping
Electrocardiography / methods
Electrophysiology / methods
Female
Fontan Procedure
Heart Valves / physiopathology
Humans
Male
Middle Aged
Reproducibility of Results
Tomography, X-Ray Computed
Grant Support
ID/Acronym/Agency:
R01 HL033343-26/HL/NHLBI NIH HHS; R01 HL033343-27/HL/NHLBI NIH HHS; R01 HL049054/HL/NHLBI NIH HHS; R01 HL049054-18/HL/NHLBI NIH HHS; R01-HL-032257/HL/NHLBI NIH HHS; R01-HL-085113/HL/NHLBI NIH HHS; R01-HL-49054/HL/NHLBI NIH HHS; R37-HL-33343/HL/NHLBI NIH HHS; UL1 RR024992/RR/NCRR NIH HHS; UL1 TR000448/TR/NCATS NIH HHS
Comments/Corrections

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