Abstract
Rotors have been related to atrial fibrillation (AF) maintenance. We analyzed the behavior of rotors in persistent AF (persAF) utilizing a novel non-contact methodology and compared this to real time dominant frequency (DF) analysis. 2048 noncontact virtual unipolar atrial electrograms (VEGMs) were collected simultaneously (EnSite Array, St. Jude Medical) from 10 persAF patients (duration: 34 ± 25 months) undergoing left atrial (LA) ablation. After QRST-removal, FFT was used to identify the global DF of the LA (range 4–10 Hz; 1 s time-window; 50 % overlap; highest DF (HDF) (DF −0.25 Hz); up to 20 s/patient). The organization index (OI) was measured and phase was found via Hilbert-transform. Phase singularities (PSs) were tracked and were categorized according to their lifespan into short (lifespan 100 ms). A total of 4578 PSs were tracked. 5.05 % (IQR: 2.75 ∼ 30.25 %) of the tracked PSs were long-lived and were observed in 11 % (IQR: 2.75 ∼ 17.5 %) of the windows. The windows with rotors showed significantly higher HDF (mean ± SD, 8.0 ± 0.43 Hz vs 7.71 ± 0.50 Hz, p< 0.0001) and lower OI (0.76 ± 0.04 vs 0.79 ± 0.03, p< 0.0001) when compared with the short-lived PSs windows. During persAF, the LA showed distinct behaviors as characterized by rotors. Often, no rotors were observed during sustained AF and, when present, the rotors continually switched between organized and disorganized behaviors. Long-lived rotors correlated with higher atrial rates. Our results suggest that rotors are not the sole perpetuating mechanism in persAF.
Highlights
Atrial Fibrillation (AF) is the most common arrhythmia and currently affects about 5 million people in the United States [1], and more than 0.5 million of people in the UK had AF in 1995 [2]
Our results suggest that rotors are not the sole perpetuating mechanism in persistent AF (persAF)
We analyzed the behavior of rotors in persistent AF utilizing a novel noncontact methodology and compared this to dominant frequency (DF) analysis
Summary
Atrial Fibrillation (AF) is the most common arrhythmia and currently affects about 5 million people in the United States [1], and more than 0.5 million of people in the UK had AF in 1995 [2]. Many animal models and human fibrillation studies revealed AF is maintained by localized electrical rotors and focal sources [4, 5]. In a recent study [6], named CONFIRM (Conventional ablation with or without Focal Impulse and Rotor Modulation) trial, it was found that when these localized areas, which were usually about two sites in every patient, were targeted for ablation, AF terminated, or substantially slowed down (increase in AF cycle length) in about 86% of patients. We focused on rotor dynamics after DF guided ablation whether one or more ‘leading rotors’ are seen that could potentially sustain AF. We evaluated whether the ablation revealed any significant anatomical differences in activation frequencies, AF organization, rotor location, and dynamics
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