Targeting Atrial Fibrillation Rotors
نویسنده
چکیده
T he hypothesis that rotors or areas of rapid reentry are critical to maintenance of atrial fibrillation (AF) has gained considerable currency with clinical data supporting enhanced efficacy when targeting these sites in AF ablation (1–3). Regions bordering AF rotors have been shown to generate high wavebreak density (HWD) that corresponds to complex fractionated atrial electrograms (CFAEs). CFAE ablation does not appear to be helpful in the elimination of AF, yet the mechanistic reason for this is poorly understood. In this issue of JACC: Clinical Electrophysiology, Yamazaki et al. (4) examine the underlying spatial distribution of AF rotors in comparison to regions of HWD/CFAE and the response of AF to ablative and modeled influences on these substrates. Langendorff-perfused sheep hearts underwent induction of sustained AF using an acetylcholine (ACh)/atrial stimulation model.
منابع مشابه
Electrophysiological Rotor Ablation in In-Silico Modeling of Atrial Fibrillation: Comparisons with Dominant Frequency, Shannon Entropy, and Phase Singularity
BACKGROUND Although rotors have been considered among the drivers of atrial fibrillation (AF), the rotor definition is inconsistent. We evaluated the nature of rotors in 2D and 3D in- silico models of persistent AF (PeAF) by analyzing phase singularity (PS), dominant frequency (DF), Shannon entropy (ShEn), and complex fractionated atrial electrogram cycle length (CFAE-CL) and their ablation. ...
متن کاملMapping Atrial Fibrillation: 2015 Update.
Atrial fibrillation requires a trigger that initiates the arrhythmia and substrate that favors perpetuation. Cardiac mapping is necessary to locate triggers and substrate so that an ablation strategy can be optimized. The most commonly used cardiac mapping approach is isochronal or activation mapping, which aims to create a spatial model of electrical wavefront propagation. Historically, activa...
متن کاملFocal Impulse And Rotor Mapping (FIRM): Conceptualizing And Treating Atrial Fibrillation.
Current approaches for the ablation of atrial fibrillation are often effective, but only partially rooted in mechanistic understanding. Accordingly, they are unable to predict whether a given patient will or will not do well, or which lesions sets should or should not be performed - in any given patient. This goal would require clearer mechanistic definition of what sustains AF after it has bee...
متن کاملThe Major Role of IK1 in Mechanisms of Rotor Drift in the Atria: A Computational Study
Maintenance of paroxysmal atrial fibrillation (AF) by fast rotors in the left atrium (LA) or at the pulmonary veins (PVs) is not fully understood. This review describes the role of the heterogeneous distribution of transmembrane currents in the PVs and LA junction (PV-LAJ) in the localization of rotors in the PVs. Experimentally observed heterogeneities in IK1, IKs, IKr, Ito, and ICaL in the PV...
متن کاملDynamic Approximate Entropy Electroanatomic Maps Detect Rotors in a Simulated Atrial Fibrillation Model
There is evidence that rotors could be drivers that maintain atrial fibrillation. Complex fractionated atrial electrograms have been located in rotor tip areas. However, the concept of electrogram fractionation, defined using time intervals, is still controversial as a tool for locating target sites for ablation. We hypothesize that the fractionation phenomenon is better described using non-lin...
متن کامل