Mechanisms of persistent atrial fibrillation and recurrences within 12 months post-ablation: Non-invasive mapping with electrocardiographic imaging
IntroductionCatheter ablation of persistent AF has not been consistently successful in terminating AF or preventing arrhythmia recurrences. Non-invasive Electrocardiographic Imaging (ECGI) can help to understand recurrences by mapping the mechanisms of pre-ablation AF and comparing them with the pat...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1052195/full |
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| author | Ramya Vijayakumar Ramya Vijayakumar Mitchell N. Faddis Mitchell N. Faddis Phillip S. Cuculich Phillip S. Cuculich Yoram Rudy Yoram Rudy Yoram Rudy |
| author_facet | Ramya Vijayakumar Ramya Vijayakumar Mitchell N. Faddis Mitchell N. Faddis Phillip S. Cuculich Phillip S. Cuculich Yoram Rudy Yoram Rudy Yoram Rudy |
| author_sort | Ramya Vijayakumar |
| collection | DOAJ |
| description | IntroductionCatheter ablation of persistent AF has not been consistently successful in terminating AF or preventing arrhythmia recurrences. Non-invasive Electrocardiographic Imaging (ECGI) can help to understand recurrences by mapping the mechanisms of pre-ablation AF and comparing them with the patterns of recurrent arrhythmias in the same patient.MethodsSeventeen persistent AF patients underwent ECGI before their first catheter ablation. Time-domain activation maps and phase progression maps were obtained on the bi-atrial epicardium. Location of arrhythmogenic drivers were annotated on the bi-atrial anatomy. Activation and phase movies were examined to understand the wavefront dynamics during AF. Eight patients recurred within 12 months of ablation and underwent a follow-up ECGI. Driver locations and movies were compared for pre- and post-ablation AF.ResultsA total of 243 focal drivers were mapped during pre-ablation AF. 62% of the drivers were mapped in the left atrium (LA). The pulmonary vein region harbored most of the drivers (43%). 35% of the drivers were mapped in the right atrium (RA). 59% (10/17) and 53% (9/17) of patients had repetitive sources in the left pulmonary veins (LPV) and left atrial appendage (LAA), and the lower half of RA, respectively. All patients had focal drivers. 29% (5/17) of patients had macro-reentry waves. 24% (4/17) of patients had rotors. Activation patterns during persistent AF varied from single macro-reentry to complex activity with multiple simultaneous wavefronts in both atria, resulting in frequent wave collisions. A total of 76 focal driver activities were mapped in 7/8 patients during recurrence. 59% of the post-ablation AF drivers were mapped in the LA. The pulmonary vein region harbored 50% of total drivers. 39% of sources were mapped in the RA. AF complexity remained similar post-ablation. 58% (44/76) of pre-ablation sources persisted during recurrence. 38% (3/8) of patients had macro-reentry and one patient had rotors.ConclusionECGI provides patient-specific information on mechanisms of persistent AF and recurrent arrhythmia. More than half pre-ablation sources repeated during post-ablation recurrence. This study provides direct evidence for drivers that persist days and months after the ablation procedure. Patient-tailored bi-atrial ablation is needed to successfully target persistent AF and prevent recurrence. ECGI can potentially predict recurrence and assist in choice of therapy. |
| first_indexed | 2024-04-13T07:54:21Z |
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| id | doaj.art-1225dc8883b54eb89346d2b8876efebc |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-13T07:54:21Z |
| publishDate | 2022-11-01 |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-1225dc8883b54eb89346d2b8876efebc2022-12-22T02:55:26ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-11-01910.3389/fcvm.2022.10521951052195Mechanisms of persistent atrial fibrillation and recurrences within 12 months post-ablation: Non-invasive mapping with electrocardiographic imagingRamya Vijayakumar0Ramya Vijayakumar1Mitchell N. Faddis2Mitchell N. Faddis3Phillip S. Cuculich4Phillip S. Cuculich5Yoram Rudy6Yoram Rudy7Yoram Rudy8Department of Surgery, Washington University School of Medicine, St. Louis, MO, United StatesCardiac Bioelectricity and Arrhythmia Center, Washington University in St. Louis, St. Louis, MO, United StatesCardiac Bioelectricity and Arrhythmia Center, Washington University in St. Louis, St. Louis, MO, United StatesDivision of Cardiology, Department of Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, United StatesCardiac Bioelectricity and Arrhythmia Center, Washington University in St. Louis, St. Louis, MO, United StatesDivision of Cardiology, Department of Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, United StatesCardiac Bioelectricity and Arrhythmia Center, Washington University in St. Louis, St. Louis, MO, United StatesDivision of Cardiology, Department of Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, United StatesDepartment of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United StatesIntroductionCatheter ablation of persistent AF has not been consistently successful in terminating AF or preventing arrhythmia recurrences. Non-invasive Electrocardiographic Imaging (ECGI) can help to understand recurrences by mapping the mechanisms of pre-ablation AF and comparing them with the patterns of recurrent arrhythmias in the same patient.MethodsSeventeen persistent AF patients underwent ECGI before their first catheter ablation. Time-domain activation maps and phase progression maps were obtained on the bi-atrial epicardium. Location of arrhythmogenic drivers were annotated on the bi-atrial anatomy. Activation and phase movies were examined to understand the wavefront dynamics during AF. Eight patients recurred within 12 months of ablation and underwent a follow-up ECGI. Driver locations and movies were compared for pre- and post-ablation AF.ResultsA total of 243 focal drivers were mapped during pre-ablation AF. 62% of the drivers were mapped in the left atrium (LA). The pulmonary vein region harbored most of the drivers (43%). 35% of the drivers were mapped in the right atrium (RA). 59% (10/17) and 53% (9/17) of patients had repetitive sources in the left pulmonary veins (LPV) and left atrial appendage (LAA), and the lower half of RA, respectively. All patients had focal drivers. 29% (5/17) of patients had macro-reentry waves. 24% (4/17) of patients had rotors. Activation patterns during persistent AF varied from single macro-reentry to complex activity with multiple simultaneous wavefronts in both atria, resulting in frequent wave collisions. A total of 76 focal driver activities were mapped in 7/8 patients during recurrence. 59% of the post-ablation AF drivers were mapped in the LA. The pulmonary vein region harbored 50% of total drivers. 39% of sources were mapped in the RA. AF complexity remained similar post-ablation. 58% (44/76) of pre-ablation sources persisted during recurrence. 38% (3/8) of patients had macro-reentry and one patient had rotors.ConclusionECGI provides patient-specific information on mechanisms of persistent AF and recurrent arrhythmia. More than half pre-ablation sources repeated during post-ablation recurrence. This study provides direct evidence for drivers that persist days and months after the ablation procedure. Patient-tailored bi-atrial ablation is needed to successfully target persistent AF and prevent recurrence. ECGI can potentially predict recurrence and assist in choice of therapy.https://www.frontiersin.org/articles/10.3389/fcvm.2022.1052195/fullpanoramic mappinghuman persistent atrial fibrillationcatheter ablationpostablation arrhythmia recurrenceelectrocardiographic imaging (ECGI) |
| spellingShingle | Ramya Vijayakumar Ramya Vijayakumar Mitchell N. Faddis Mitchell N. Faddis Phillip S. Cuculich Phillip S. Cuculich Yoram Rudy Yoram Rudy Yoram Rudy Mechanisms of persistent atrial fibrillation and recurrences within 12 months post-ablation: Non-invasive mapping with electrocardiographic imaging Frontiers in Cardiovascular Medicine panoramic mapping human persistent atrial fibrillation catheter ablation postablation arrhythmia recurrence electrocardiographic imaging (ECGI) |
| title | Mechanisms of persistent atrial fibrillation and recurrences within 12 months post-ablation: Non-invasive mapping with electrocardiographic imaging |
| title_full | Mechanisms of persistent atrial fibrillation and recurrences within 12 months post-ablation: Non-invasive mapping with electrocardiographic imaging |
| title_fullStr | Mechanisms of persistent atrial fibrillation and recurrences within 12 months post-ablation: Non-invasive mapping with electrocardiographic imaging |
| title_full_unstemmed | Mechanisms of persistent atrial fibrillation and recurrences within 12 months post-ablation: Non-invasive mapping with electrocardiographic imaging |
| title_short | Mechanisms of persistent atrial fibrillation and recurrences within 12 months post-ablation: Non-invasive mapping with electrocardiographic imaging |
| title_sort | mechanisms of persistent atrial fibrillation and recurrences within 12 months post ablation non invasive mapping with electrocardiographic imaging |
| topic | panoramic mapping human persistent atrial fibrillation catheter ablation postablation arrhythmia recurrence electrocardiographic imaging (ECGI) |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1052195/full |
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