Mechanisms responsible for the initiation and maintenance of atrial fibrillation assessed by non-contact mapping system

Seung-Woon Rha, Young Hoon Kim, Mun Kyung Hong, Young Moo Ro, Cheol Ung Choi, Soon Yong Suh, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh

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Abstract

Background: This study is aimed to assess the initiation and maintenance mechanisms of atrial fibrillation (AF) and their relationships with the anatomical structures of the left atrium (LA) and pulmonary veins (PVs). Methods: Thirty-seven patients (pts; 33 men, mean age 50 ± 12, range 25-68 years) with paroxysmal AF (n = 29) and persistent AF (n = 8) who underwent mapping of the LA and PV using 3D non-contact endocardial mapping system (EnSite 3000) were included. Atrial premature complexes (APCs) which triggered the initiation of AF lasted longer than 1 min were mapped and the activation sequence on isopotential color maps was analyzed. Results: Wave front dynamics and the relationship with the underlying anatomical structures were assessed. APCs from PV were related to the initiation of AF, but not to the maintenance of AF in 59.5% of the pts (focally triggered type) whereas APCs from PV not only initiated AF but also maintained AF without continuous triggering in 27% (focally driven type). Mixed type and indeterminate type of AF was in 4.5% and 13.5%, respectively. During AF, the mean number of wavelet was 1.45 (maximum 3 in 76.5%). Anatomical structures showing frequent wave break and slow conduction were mostly located at the septopulmonary bundle (86.5%) and the posterior LA roof between left superior PV and right superior PV (54.1%). Conclusion: Focal repetitive activity from PV played an important role in both initiation and maintenance of AF using NCM study. Specific anatomical structures such as septopulmonary bundle or posterior LA roof were associated with the spontaneous wave break and heterogeneous conduction delay, which was also appears to be important in the maintenance of AF.

Original languageEnglish
Pages (from-to)218-226
Number of pages9
JournalInternational Journal of Cardiology
Volume124
Issue number2
DOIs
Publication statusPublished - 2008 Feb 29

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Atrial Fibrillation
Maintenance
Pulmonary Veins
Atrial Premature Complexes
Heart Atria
Color

Keywords

  • Atrial fibrillation
  • Non-contact mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{44404b4484554e33abc49951549c2cc4,
title = "Mechanisms responsible for the initiation and maintenance of atrial fibrillation assessed by non-contact mapping system",
abstract = "Background: This study is aimed to assess the initiation and maintenance mechanisms of atrial fibrillation (AF) and their relationships with the anatomical structures of the left atrium (LA) and pulmonary veins (PVs). Methods: Thirty-seven patients (pts; 33 men, mean age 50 ± 12, range 25-68 years) with paroxysmal AF (n = 29) and persistent AF (n = 8) who underwent mapping of the LA and PV using 3D non-contact endocardial mapping system (EnSite 3000) were included. Atrial premature complexes (APCs) which triggered the initiation of AF lasted longer than 1 min were mapped and the activation sequence on isopotential color maps was analyzed. Results: Wave front dynamics and the relationship with the underlying anatomical structures were assessed. APCs from PV were related to the initiation of AF, but not to the maintenance of AF in 59.5{\%} of the pts (focally triggered type) whereas APCs from PV not only initiated AF but also maintained AF without continuous triggering in 27{\%} (focally driven type). Mixed type and indeterminate type of AF was in 4.5{\%} and 13.5{\%}, respectively. During AF, the mean number of wavelet was 1.45 (maximum 3 in 76.5{\%}). Anatomical structures showing frequent wave break and slow conduction were mostly located at the septopulmonary bundle (86.5{\%}) and the posterior LA roof between left superior PV and right superior PV (54.1{\%}). Conclusion: Focal repetitive activity from PV played an important role in both initiation and maintenance of AF using NCM study. Specific anatomical structures such as septopulmonary bundle or posterior LA roof were associated with the spontaneous wave break and heterogeneous conduction delay, which was also appears to be important in the maintenance of AF.",
keywords = "Atrial fibrillation, Non-contact mapping",
author = "Seung-Woon Rha and Kim, {Young Hoon} and Hong, {Mun Kyung} and Ro, {Young Moo} and Choi, {Cheol Ung} and Suh, {Soon Yong} and Kim, {Jin Won} and Kim, {Eung Ju} and Park, {Chang Gyu} and Seo, {Hong Seog} and Oh, {Dong Joo}",
year = "2008",
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doi = "10.1016/j.ijcard.2007.02.013",
language = "English",
volume = "124",
pages = "218--226",
journal = "International Journal of Cardiology",
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TY - JOUR

T1 - Mechanisms responsible for the initiation and maintenance of atrial fibrillation assessed by non-contact mapping system

AU - Rha, Seung-Woon

AU - Kim, Young Hoon

AU - Hong, Mun Kyung

AU - Ro, Young Moo

AU - Choi, Cheol Ung

AU - Suh, Soon Yong

AU - Kim, Jin Won

AU - Kim, Eung Ju

AU - Park, Chang Gyu

AU - Seo, Hong Seog

AU - Oh, Dong Joo

PY - 2008/2/29

Y1 - 2008/2/29

N2 - Background: This study is aimed to assess the initiation and maintenance mechanisms of atrial fibrillation (AF) and their relationships with the anatomical structures of the left atrium (LA) and pulmonary veins (PVs). Methods: Thirty-seven patients (pts; 33 men, mean age 50 ± 12, range 25-68 years) with paroxysmal AF (n = 29) and persistent AF (n = 8) who underwent mapping of the LA and PV using 3D non-contact endocardial mapping system (EnSite 3000) were included. Atrial premature complexes (APCs) which triggered the initiation of AF lasted longer than 1 min were mapped and the activation sequence on isopotential color maps was analyzed. Results: Wave front dynamics and the relationship with the underlying anatomical structures were assessed. APCs from PV were related to the initiation of AF, but not to the maintenance of AF in 59.5% of the pts (focally triggered type) whereas APCs from PV not only initiated AF but also maintained AF without continuous triggering in 27% (focally driven type). Mixed type and indeterminate type of AF was in 4.5% and 13.5%, respectively. During AF, the mean number of wavelet was 1.45 (maximum 3 in 76.5%). Anatomical structures showing frequent wave break and slow conduction were mostly located at the septopulmonary bundle (86.5%) and the posterior LA roof between left superior PV and right superior PV (54.1%). Conclusion: Focal repetitive activity from PV played an important role in both initiation and maintenance of AF using NCM study. Specific anatomical structures such as septopulmonary bundle or posterior LA roof were associated with the spontaneous wave break and heterogeneous conduction delay, which was also appears to be important in the maintenance of AF.

AB - Background: This study is aimed to assess the initiation and maintenance mechanisms of atrial fibrillation (AF) and their relationships with the anatomical structures of the left atrium (LA) and pulmonary veins (PVs). Methods: Thirty-seven patients (pts; 33 men, mean age 50 ± 12, range 25-68 years) with paroxysmal AF (n = 29) and persistent AF (n = 8) who underwent mapping of the LA and PV using 3D non-contact endocardial mapping system (EnSite 3000) were included. Atrial premature complexes (APCs) which triggered the initiation of AF lasted longer than 1 min were mapped and the activation sequence on isopotential color maps was analyzed. Results: Wave front dynamics and the relationship with the underlying anatomical structures were assessed. APCs from PV were related to the initiation of AF, but not to the maintenance of AF in 59.5% of the pts (focally triggered type) whereas APCs from PV not only initiated AF but also maintained AF without continuous triggering in 27% (focally driven type). Mixed type and indeterminate type of AF was in 4.5% and 13.5%, respectively. During AF, the mean number of wavelet was 1.45 (maximum 3 in 76.5%). Anatomical structures showing frequent wave break and slow conduction were mostly located at the septopulmonary bundle (86.5%) and the posterior LA roof between left superior PV and right superior PV (54.1%). Conclusion: Focal repetitive activity from PV played an important role in both initiation and maintenance of AF using NCM study. Specific anatomical structures such as septopulmonary bundle or posterior LA roof were associated with the spontaneous wave break and heterogeneous conduction delay, which was also appears to be important in the maintenance of AF.

KW - Atrial fibrillation

KW - Non-contact mapping

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U2 - 10.1016/j.ijcard.2007.02.013

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