Local Electrical Dyssynchrony during Atrial Fibrillation: Theoretical Considerations and Initial Catheter Ablation Results
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Local Electrical Dyssynchrony during Atrial Fibrillation: Theoretical Considerations and Initial Catheter Ablation Results. / Kuklik, Pawel; Schäffer, Benjamin; Hoffmann, Boris A; Ganesan, Anand N; Schreiber, Doreen; Moser, Julia M; Akbulak, Ruken Ö; Sultan, Arian; Steven, Daniel; Maesen, Bart; Schotten, Ulrich; Meyer, Christian; Willems, Stephan.
in: PLOS ONE, Jahrgang 11, Nr. 10, 2016, S. e0164236.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Local Electrical Dyssynchrony during Atrial Fibrillation: Theoretical Considerations and Initial Catheter Ablation Results
AU - Kuklik, Pawel
AU - Schäffer, Benjamin
AU - Hoffmann, Boris A
AU - Ganesan, Anand N
AU - Schreiber, Doreen
AU - Moser, Julia M
AU - Akbulak, Ruken Ö
AU - Sultan, Arian
AU - Steven, Daniel
AU - Maesen, Bart
AU - Schotten, Ulrich
AU - Meyer, Christian
AU - Willems, Stephan
PY - 2016
Y1 - 2016
N2 - BACKGROUND: Electrogram-based identification of the regions maintaining persistent Atrial Fibrillation (AF) is a subject of ongoing debate. Here, we explore the concept of local electrical dyssynchrony to identify AF drivers.METHODS AND RESULTS: Local electrical dyssynchrony was calculated using mean phase coherence. High-density epicardial mapping along with mathematical model were used to explore the link between local dyssynchrony and properties of wave conduction. High-density mapping showed a positive correlation between the dyssynchrony and number of fibrillatory waves (R2 = 0.68, p<0.001). In the mathematical model, virtual ablation at high dyssynchrony regions resulted in conduction regularization. The clinical study consisted of eighteen patients undergoing catheter ablation of persistent AF. High-density maps of left atrial (LA) were constructed using a circular mapping catheter. After pulmonary vein isolation, regions with the top 10% of the highest dyssynchrony in LA were targeted during ablation and followed with ablation of complex atrial electrograms. Catheter ablation resulted in termination during ablation at high dyssynchrony regions in 7 (41%) patients. In another 4 (24%) patients, transient organization was observed. In 6 (35%) there was no clear effect. Long-term follow-up showed 65% AF freedom at 1 year and 22% at 2 years.CONCLUSIONS: Local electrical dyssynchrony provides a reasonable estimator of regional AF complexity defined as the number of fibrillatory waves. Additionally, it points to regions of dynamical instability related with action potential alternans. However, despite those characteristics, its utility in guiding catheter ablation of AF is limited suggesting other factors are responsible for AF persistence.
AB - BACKGROUND: Electrogram-based identification of the regions maintaining persistent Atrial Fibrillation (AF) is a subject of ongoing debate. Here, we explore the concept of local electrical dyssynchrony to identify AF drivers.METHODS AND RESULTS: Local electrical dyssynchrony was calculated using mean phase coherence. High-density epicardial mapping along with mathematical model were used to explore the link between local dyssynchrony and properties of wave conduction. High-density mapping showed a positive correlation between the dyssynchrony and number of fibrillatory waves (R2 = 0.68, p<0.001). In the mathematical model, virtual ablation at high dyssynchrony regions resulted in conduction regularization. The clinical study consisted of eighteen patients undergoing catheter ablation of persistent AF. High-density maps of left atrial (LA) were constructed using a circular mapping catheter. After pulmonary vein isolation, regions with the top 10% of the highest dyssynchrony in LA were targeted during ablation and followed with ablation of complex atrial electrograms. Catheter ablation resulted in termination during ablation at high dyssynchrony regions in 7 (41%) patients. In another 4 (24%) patients, transient organization was observed. In 6 (35%) there was no clear effect. Long-term follow-up showed 65% AF freedom at 1 year and 22% at 2 years.CONCLUSIONS: Local electrical dyssynchrony provides a reasonable estimator of regional AF complexity defined as the number of fibrillatory waves. Additionally, it points to regions of dynamical instability related with action potential alternans. However, despite those characteristics, its utility in guiding catheter ablation of AF is limited suggesting other factors are responsible for AF persistence.
KW - Aged
KW - Atrial Fibrillation/physiopathology
KW - Catheter Ablation/methods
KW - Combined Modality Therapy
KW - Epicardial Mapping/methods
KW - Female
KW - Heart Atria/physiopathology
KW - Humans
KW - Male
KW - Middle Aged
KW - Models, Theoretical
KW - Pilot Projects
KW - Treatment Outcome
U2 - 10.1371/journal.pone.0164236
DO - 10.1371/journal.pone.0164236
M3 - SCORING: Journal article
C2 - 27780243
VL - 11
SP - e0164236
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 10
ER -
