Dynamic transmurality: Cardiac Optical Mapping reveals Waves Travel across Transmural Ablation Lines

Cardiac ablation is increasingly used to interdict the complex propagation of excitatory waves during atrial fibrillation. While such procedures are useful, they can often fail. Here we use fluorescence imaging to observe the electrical activity of an ablated porcine heart. We find that, while ablation lines do attenuate cardiac waves, the attenuation is incomplete. A remnant of the incident wave survives passage through the ablation barrier, albeit as a subthreshold signal. More importantly, we have found that these subthreshold signals may add constructively and thereby dynamically reduce the effective attenuation, an effect which we call “dynamic transmurality”. We suspect this as a factor in the persistence of arrhythmia after ablative procedures.