Unraveling the Underlying Arrhythmia Mechanism in Persistent Atrial Fibrillation: Results From the STARLIGHT Study
Jazyk angličtina Země Spojené státy americké Médium print
Typ dokumentu časopisecké články, multicentrická studie, pozorovací studie, práce podpořená grantem
Grantová podpora
Department of Health - United Kingdom
Odkazy
PubMed
29858382
DOI
10.1161/circep.117.005897
PII: CIRCEP.117.005897
Knihovny.cz E-zdroje
- Klíčová slova
- arrhythmias, cardiac, atrial fibrillation, electrodes, heart atria, humans,
- MeSH
- akční potenciály * MeSH
- časové faktory MeSH
- elektrofyziologické techniky kardiologické * MeSH
- fibrilace síní diagnóza patofyziologie MeSH
- kardiostimulace umělá MeSH
- lidé středního věku MeSH
- lidé MeSH
- prediktivní hodnota testů MeSH
- senioři MeSH
- srdeční frekvence MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
BACKGROUND: The mechanisms that initiate and sustain persistent atrial fibrillation are not well characterized. Ablation results remain significantly worse than in paroxysmal atrial fibrillation in which the mechanism is better understood and subsequent targeted therapy has been developed. The aim of this study was to characterize and quantify patterns of activation during atrial fibrillation using contact mapping. METHODS: Patients with persistent atrial fibrillation (n=14; mean age, 61±8 years; ejection fraction, 59±10%) underwent simultaneous biatrial contact mapping with 64 electrode catheters. The atrial electrograms were transformed into phase, and subsequent spatiotemporal mapping was performed to identify phase singularities (PSs). RESULTS: PSs were located in both atria, but we observed more PSs in the left atrium compared with the right atrium (779±302, 552±235; P=0.015). Although some PSs of duration sufficient to complete >1 rotation were detected, the maximum PS duration was only 1150 ms, and the vast majority (97%) of PSs persisted for too short a period to complete a full rotation. Although in selected patients there was evidence of PS local clustering, overall, PSs were distributed globally throughout both chambers with no clear anatomic predisposition. In a subset of patients (n=7), analysis was repeated using an alternative established atrial PS mapping technique, which confirmed our initial findings. CONCLUSIONS: No sustained rotors or localized drivers were detected, and instead, the mechanism of arrhythmia maintenance was consistent with the multiple wavelet hypothesis, with passive activation of short-lived rotational activity. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01765075.
Boston Scientific Corp St Paul MN
Department of Cardiology Guy's and St Thomas' Hospital London United Kingdom
Department of Cardiology Na Holmolce Hospital Prague Czech Republic
Department of Imaging Sciences and Biomedical Engineering King's College London United Kingdom
INSIGNEO Institute for In Silico Medicine University of Sheffield United Kingdom
PubMed Roney, Caroline R [corrected to Roney, Caroline H]
ClinicalTrials.gov
NCT01765075
