| Noninvasive characterization of epicardial activation in humans with diverse atrial fibrillation patterns. | |
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MedLine Citation:
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PMID: 20855661 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Phillip S Cuculich; Yong Wang; Bruce D Lindsay; Mitchell N Faddis; Richard B Schuessler; Ralph J Damiano; Li Li; Yoram Rudy |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2010-09-20 |
Journal Detail:
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Title: Circulation Volume: 122 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-10-05 Completed Date: 2010-10-29 Revised Date: 2013-03-08 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 1364-72 Citation Subset: AIM; IM |
Affiliation:
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Cardiac Bioelectricity Center, One Brookings Drive, St Louis, MO 63130-4899, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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R01 HL033343-26/HL/NHLBI NIH HHS; R01 HL033343-27/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 | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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