Selecting repetitive focal and rotational activation patterns with the highest probability of being a source of atrial fibrillation
Introduction: Repetitive focal and rotational activation patterns are currently used as additional ablation targets for atrial fibrillation (AF). However, there is no evidence that all these detected targets are actual sources of AF. In this paper, we present an approach that detects and ranks AF ac...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-03-01
|
| Series: | Journal of Molecular and Cellular Cardiology Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772976124000047 |
| _version_ | 1827315498444914688 |
|---|---|
| author | Ben J.M. Hermans Ozan Özgül Michael Wolf Victor G. Marques Arne van Hunnik Sander Verheule Sevasti-Maria Chaldoupi Dominik Linz Milad El Haddad Mattias Duytschaever Pietro Bonizzi Kevin Vernooy Sébastien Knecht Stef Zeemering Ulrich Schotten |
| author_facet | Ben J.M. Hermans Ozan Özgül Michael Wolf Victor G. Marques Arne van Hunnik Sander Verheule Sevasti-Maria Chaldoupi Dominik Linz Milad El Haddad Mattias Duytschaever Pietro Bonizzi Kevin Vernooy Sébastien Knecht Stef Zeemering Ulrich Schotten |
| author_sort | Ben J.M. Hermans |
| collection | DOAJ |
| description | Introduction: Repetitive focal and rotational activation patterns are currently used as additional ablation targets for atrial fibrillation (AF). However, there is no evidence that all these detected targets are actual sources of AF. In this paper, we present an approach that detects and ranks AF activation patterns not only based on the degree of pattern repetitiveness but also on the extent to which they are able to entrain their vicinity. This new technique might enable selecting the site with the highest probability of being a source for AF. Methods: We retrospectively analyzed high-density bi-atrial sequential mapping in ablation-naive persistent AF patients (n = 13, PentaRay catheter, 30s recordings). Repetitive focal and rotational activation patterns were detected based on local activation time annotation of unipolar electrograms. The spatial stability was determined as local repetitive pattern duration. The entrainment capability was defined as the average time a directionally coherent repetitive activation pattern was observed in adjacent recordings. Results: A total of 459 recordings were analyzed (35 ± 5 per patient). We detected 131 repetitive focal (10 ± 4 per patient) and 56 rotational activation patterns (4 ± 3 per patient) in total. Focal patterns were more repetitive than rotational patterns (median [IQR] 0.7 [0.4–1.3] seconds vs. 0.5 [0.4–0.6] seconds, p < 0.001 Mann-Whitney U test). By applying a 90th percentile threshold to both local and directionally coherent adjacent repetitiveness, we identified 10 sites (9 focal and 1 rotational) in 7 patients as the most probable sources. The majority of these sites were in the upper right atrium or left pulmonary vein region. Notably, in 6 patients (46 %), no probable sources were detected using this threshold. Conclusion: This study introduces a novel technique to select the repetitive focal or rotational pattern with the highest probability of being a source. We observed that only a minority of repetitive focal or rotational patterns seem to be able to entrain their vicinity and thereby are likely to serve as sources of AF. |
| first_indexed | 2024-03-08T05:13:27Z |
| format | Article |
| id | doaj.art-ba7ef4332fdb47318e9939536224ab85 |
| institution | Directory Open Access Journal |
| issn | 2772-9761 |
| language | English |
| last_indexed | 2024-04-24T22:57:22Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Molecular and Cellular Cardiology Plus |
| spelling | doaj.art-ba7ef4332fdb47318e9939536224ab852024-03-18T04:34:56ZengElsevierJournal of Molecular and Cellular Cardiology Plus2772-97612024-03-017100064Selecting repetitive focal and rotational activation patterns with the highest probability of being a source of atrial fibrillationBen J.M. Hermans0Ozan Özgül1Michael Wolf2Victor G. Marques3Arne van Hunnik4Sander Verheule5Sevasti-Maria Chaldoupi6Dominik Linz7Milad El Haddad8Mattias Duytschaever9Pietro Bonizzi10Kevin Vernooy11Sébastien Knecht12Stef Zeemering13Ulrich Schotten14Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, the Netherlands; Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Corresponding author at: Department of Physiology, Maastricht University, PO Box 616, 6200MD Maastricht, the Netherlands.Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, the NetherlandsDepartment of Cardiology, AZ Sint-Jan Brugge, Bruges, BelgiumDepartment of Physiology, Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, the NetherlandsDepartment of Physiology, Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, the NetherlandsDepartment of Physiology, Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, the NetherlandsDepartment of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the NetherlandsDepartment of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the NetherlandsDepartment of Cardiology, AZ Sint-Jan Brugge, Bruges, BelgiumDepartment of Cardiology, AZ Sint-Jan Brugge, Bruges, BelgiumDepartment of Advanced Computing Sciences, Maastricht University, Maastricht, the NetherlandsDepartment of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the NetherlandsDepartment of Cardiology, AZ Sint-Jan Brugge, Bruges, BelgiumDepartment of Physiology, Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, the NetherlandsDepartment of Physiology, Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, the Netherlands; Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the NetherlandsIntroduction: Repetitive focal and rotational activation patterns are currently used as additional ablation targets for atrial fibrillation (AF). However, there is no evidence that all these detected targets are actual sources of AF. In this paper, we present an approach that detects and ranks AF activation patterns not only based on the degree of pattern repetitiveness but also on the extent to which they are able to entrain their vicinity. This new technique might enable selecting the site with the highest probability of being a source for AF. Methods: We retrospectively analyzed high-density bi-atrial sequential mapping in ablation-naive persistent AF patients (n = 13, PentaRay catheter, 30s recordings). Repetitive focal and rotational activation patterns were detected based on local activation time annotation of unipolar electrograms. The spatial stability was determined as local repetitive pattern duration. The entrainment capability was defined as the average time a directionally coherent repetitive activation pattern was observed in adjacent recordings. Results: A total of 459 recordings were analyzed (35 ± 5 per patient). We detected 131 repetitive focal (10 ± 4 per patient) and 56 rotational activation patterns (4 ± 3 per patient) in total. Focal patterns were more repetitive than rotational patterns (median [IQR] 0.7 [0.4–1.3] seconds vs. 0.5 [0.4–0.6] seconds, p < 0.001 Mann-Whitney U test). By applying a 90th percentile threshold to both local and directionally coherent adjacent repetitiveness, we identified 10 sites (9 focal and 1 rotational) in 7 patients as the most probable sources. The majority of these sites were in the upper right atrium or left pulmonary vein region. Notably, in 6 patients (46 %), no probable sources were detected using this threshold. Conclusion: This study introduces a novel technique to select the repetitive focal or rotational pattern with the highest probability of being a source. We observed that only a minority of repetitive focal or rotational patterns seem to be able to entrain their vicinity and thereby are likely to serve as sources of AF.http://www.sciencedirect.com/science/article/pii/S2772976124000047Atrial fibrillationElectro-anatomical mappingAF sourcesAblation |
| spellingShingle | Ben J.M. Hermans Ozan Özgül Michael Wolf Victor G. Marques Arne van Hunnik Sander Verheule Sevasti-Maria Chaldoupi Dominik Linz Milad El Haddad Mattias Duytschaever Pietro Bonizzi Kevin Vernooy Sébastien Knecht Stef Zeemering Ulrich Schotten Selecting repetitive focal and rotational activation patterns with the highest probability of being a source of atrial fibrillation Journal of Molecular and Cellular Cardiology Plus Atrial fibrillation Electro-anatomical mapping AF sources Ablation |
| title | Selecting repetitive focal and rotational activation patterns with the highest probability of being a source of atrial fibrillation |
| title_full | Selecting repetitive focal and rotational activation patterns with the highest probability of being a source of atrial fibrillation |
| title_fullStr | Selecting repetitive focal and rotational activation patterns with the highest probability of being a source of atrial fibrillation |
| title_full_unstemmed | Selecting repetitive focal and rotational activation patterns with the highest probability of being a source of atrial fibrillation |
| title_short | Selecting repetitive focal and rotational activation patterns with the highest probability of being a source of atrial fibrillation |
| title_sort | selecting repetitive focal and rotational activation patterns with the highest probability of being a source of atrial fibrillation |
| topic | Atrial fibrillation Electro-anatomical mapping AF sources Ablation |
| url | http://www.sciencedirect.com/science/article/pii/S2772976124000047 |
| work_keys_str_mv | AT benjmhermans selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation AT ozanozgul selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation AT michaelwolf selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation AT victorgmarques selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation AT arnevanhunnik selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation AT sanderverheule selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation AT sevastimariachaldoupi selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation AT dominiklinz selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation AT miladelhaddad selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation AT mattiasduytschaever selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation AT pietrobonizzi selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation AT kevinvernooy selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation AT sebastienknecht selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation AT stefzeemering selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation AT ulrichschotten selectingrepetitivefocalandrotationalactivationpatternswiththehighestprobabilityofbeingasourceofatrialfibrillation |