Local Electrical Dyssynchrony during Atrial Fibrillation: Theoretical Considerations and Initial Catheter Ablation Results
Electrogram-based identification of the regions maintaining persistent Atrial Fibrillation (AF) is a subject of ongoing debate. Here, we explore the concept of local electrical dyssynchrony to identify AF drivers. Local electrical dyssynchrony was calculated using mean phase coherence. High-density...
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| creator | Kuklik, Pawel Schäffer, Benjamin Hoffmann, Boris A Ganesan, Anand N Schreiber, Doreen Moser, Julia M Akbulak, Ruken Ö Sultan, Arian Steven, Daniel Maesen, Bart Schotten, Ulrich Meyer, Christian Willems, Stephan |
| description | Electrogram-based identification of the regions maintaining persistent Atrial Fibrillation (AF) is a subject of ongoing debate. Here, we explore the concept of local electrical dyssynchrony to identify AF drivers.
Local electrical dyssynchrony was calculated using mean phase coherence. High-density epicardial mapping along with mathematical model were used to explore the link between local dyssynchrony and properties of wave conduction. High-density mapping showed a positive correlation between the dyssynchrony and number of fibrillatory waves (R2 = 0.68, p |
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Local electrical dyssynchrony was calculated using mean phase coherence. High-density epicardial mapping along with mathematical model were used to explore the link between local dyssynchrony and properties of wave conduction. High-density mapping showed a positive correlation between the dyssynchrony and number of fibrillatory waves (R2 = 0.68, p<0.001). In the mathematical model, virtual ablation at high dyssynchrony regions resulted in conduction regularization. The clinical study consisted of eighteen patients undergoing catheter ablation of persistent AF. High-density maps of left atrial (LA) were constructed using a circular mapping catheter. After pulmonary vein isolation, regions with the top 10% of the highest dyssynchrony in LA were targeted during ablation and followed with ablation of complex atrial electrograms. Catheter ablation resulted in termination during ablation at high dyssynchrony regions in 7 (41%) patients. In another 4 (24%) patients, transient organization was observed. In 6 (35%) there was no clear effect. Long-term follow-up showed 65% AF freedom at 1 year and 22% at 2 years.
Local electrical dyssynchrony provides a reasonable estimator of regional AF complexity defined as the number of fibrillatory waves. Additionally, it points to regions of dynamical instability related with action potential alternans. However, despite those characteristics, its utility in guiding catheter ablation of AF is limited suggesting other factors are responsible for AF persistence.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0164236</identifier><identifier>PMID: 27780243</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Ablation ; Ablation (Surgery) ; Action potential ; Aged ; Analysis ; Atrial fibrillation ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Biology and Life Sciences ; Cardiac arrhythmia ; Cardiology ; Catheter Ablation - methods ; Catheters ; Combined Modality Therapy ; Complexity ; Conduction ; Density ; Dynamic stability ; Electric properties ; Electrodes ; Epicardial Mapping - methods ; Female ; Fibrillation ; Heart ; Heart Atria - physiopathology ; Heart Atria - surgery ; Humans ; Male ; Mapping ; Mathematical analysis ; Mathematical models ; Medical instruments ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Models, Theoretical ; Patients ; Phase coherence ; Pilot Projects ; Radiofrequency ablation ; Regularization ; Research and Analysis Methods ; Thoracic surgery ; Treatment Outcome ; Veins & arteries</subject><ispartof>PloS one, 2016-10, Vol.11 (10), p.e0164236-e0164236</ispartof><rights>COPYRIGHT 2016 Public Library of Science</rights><rights>2016 Kuklik et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2016 Kuklik et al 2016 Kuklik et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c725t-869d3f3204c641e2adbf6fa9d54bff5ba1b9168f98971da15d2139552bdfc0c23</citedby><cites>FETCH-LOGICAL-c725t-869d3f3204c641e2adbf6fa9d54bff5ba1b9168f98971da15d2139552bdfc0c23</cites><orcidid>0000-0001-8440-654X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079563/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079563/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27780243$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Panfilov, Alexander V</contributor><creatorcontrib>Kuklik, Pawel</creatorcontrib><creatorcontrib>Schäffer, Benjamin</creatorcontrib><creatorcontrib>Hoffmann, Boris A</creatorcontrib><creatorcontrib>Ganesan, Anand N</creatorcontrib><creatorcontrib>Schreiber, Doreen</creatorcontrib><creatorcontrib>Moser, Julia M</creatorcontrib><creatorcontrib>Akbulak, Ruken Ö</creatorcontrib><creatorcontrib>Sultan, Arian</creatorcontrib><creatorcontrib>Steven, Daniel</creatorcontrib><creatorcontrib>Maesen, Bart</creatorcontrib><creatorcontrib>Schotten, Ulrich</creatorcontrib><creatorcontrib>Meyer, Christian</creatorcontrib><creatorcontrib>Willems, Stephan</creatorcontrib><title>Local Electrical Dyssynchrony during Atrial Fibrillation: Theoretical Considerations and Initial Catheter Ablation Results</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Electrogram-based identification of the regions maintaining persistent Atrial Fibrillation (AF) is a subject of ongoing debate. Here, we explore the concept of local electrical dyssynchrony to identify AF drivers.
Local electrical dyssynchrony was calculated using mean phase coherence. High-density epicardial mapping along with mathematical model were used to explore the link between local dyssynchrony and properties of wave conduction. High-density mapping showed a positive correlation between the dyssynchrony and number of fibrillatory waves (R2 = 0.68, p<0.001). In the mathematical model, virtual ablation at high dyssynchrony regions resulted in conduction regularization. The clinical study consisted of eighteen patients undergoing catheter ablation of persistent AF. High-density maps of left atrial (LA) were constructed using a circular mapping catheter. After pulmonary vein isolation, regions with the top 10% of the highest dyssynchrony in LA were targeted during ablation and followed with ablation of complex atrial electrograms. Catheter ablation resulted in termination during ablation at high dyssynchrony regions in 7 (41%) patients. In another 4 (24%) patients, transient organization was observed. In 6 (35%) there was no clear effect. Long-term follow-up showed 65% AF freedom at 1 year and 22% at 2 years.
Local electrical dyssynchrony provides a reasonable estimator of regional AF complexity defined as the number of fibrillatory waves. Additionally, it points to regions of dynamical instability related with action potential alternans. However, despite those characteristics, its utility in guiding catheter ablation of AF is limited suggesting other factors are responsible for AF persistence.</description><subject>Ablation</subject><subject>Ablation (Surgery)</subject><subject>Action potential</subject><subject>Aged</subject><subject>Analysis</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Biology and Life Sciences</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Catheter Ablation - methods</subject><subject>Catheters</subject><subject>Combined Modality Therapy</subject><subject>Complexity</subject><subject>Conduction</subject><subject>Density</subject><subject>Dynamic stability</subject><subject>Electric properties</subject><subject>Electrodes</subject><subject>Epicardial Mapping - methods</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Heart</subject><subject>Heart Atria - physiopathology</subject><subject>Heart Atria - surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Mapping</subject><subject>Mathematical analysis</subject><subject>Mathematical models</subject><subject>Medical instruments</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Models, Theoretical</subject><subject>Patients</subject><subject>Phase coherence</subject><subject>Pilot Projects</subject><subject>Radiofrequency ablation</subject><subject>Regularization</subject><subject>Research and Analysis Methods</subject><subject>Thoracic surgery</subject><subject>Treatment Outcome</subject><subject>Veins & 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Electrical Dyssynchrony during Atrial Fibrillation: Theoretical Considerations and Initial Catheter Ablation Results</title><author>Kuklik, Pawel ; Schäffer, Benjamin ; Hoffmann, Boris A ; Ganesan, Anand N ; Schreiber, Doreen ; Moser, Julia M ; Akbulak, Ruken Ö ; Sultan, Arian ; Steven, Daniel ; Maesen, Bart ; Schotten, Ulrich ; Meyer, Christian ; Willems, Stephan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c725t-869d3f3204c641e2adbf6fa9d54bff5ba1b9168f98971da15d2139552bdfc0c23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Ablation</topic><topic>Ablation (Surgery)</topic><topic>Action potential</topic><topic>Aged</topic><topic>Analysis</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Biology and Life Sciences</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology</topic><topic>Catheter Ablation - methods</topic><topic>Catheters</topic><topic>Combined Modality Therapy</topic><topic>Complexity</topic><topic>Conduction</topic><topic>Density</topic><topic>Dynamic stability</topic><topic>Electric properties</topic><topic>Electrodes</topic><topic>Epicardial Mapping - methods</topic><topic>Female</topic><topic>Fibrillation</topic><topic>Heart</topic><topic>Heart Atria - physiopathology</topic><topic>Heart Atria - surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Mapping</topic><topic>Mathematical analysis</topic><topic>Mathematical models</topic><topic>Medical instruments</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Models, Theoretical</topic><topic>Patients</topic><topic>Phase coherence</topic><topic>Pilot Projects</topic><topic>Radiofrequency ablation</topic><topic>Regularization</topic><topic>Research and Analysis 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V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Local Electrical Dyssynchrony during Atrial Fibrillation: Theoretical Considerations and Initial Catheter Ablation Results</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2016-10-25</date><risdate>2016</risdate><volume>11</volume><issue>10</issue><spage>e0164236</spage><epage>e0164236</epage><pages>e0164236-e0164236</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Electrogram-based identification of the regions maintaining persistent Atrial Fibrillation (AF) is a subject of ongoing debate. Here, we explore the concept of local electrical dyssynchrony to identify AF drivers.
Local electrical dyssynchrony was calculated using mean phase coherence. High-density epicardial mapping along with mathematical model were used to explore the link between local dyssynchrony and properties of wave conduction. High-density mapping showed a positive correlation between the dyssynchrony and number of fibrillatory waves (R2 = 0.68, p<0.001). In the mathematical model, virtual ablation at high dyssynchrony regions resulted in conduction regularization. The clinical study consisted of eighteen patients undergoing catheter ablation of persistent AF. High-density maps of left atrial (LA) were constructed using a circular mapping catheter. After pulmonary vein isolation, regions with the top 10% of the highest dyssynchrony in LA were targeted during ablation and followed with ablation of complex atrial electrograms. Catheter ablation resulted in termination during ablation at high dyssynchrony regions in 7 (41%) patients. In another 4 (24%) patients, transient organization was observed. In 6 (35%) there was no clear effect. Long-term follow-up showed 65% AF freedom at 1 year and 22% at 2 years.
Local electrical dyssynchrony provides a reasonable estimator of regional AF complexity defined as the number of fibrillatory waves. Additionally, it points to regions of dynamical instability related with action potential alternans. However, despite those characteristics, its utility in guiding catheter ablation of AF is limited suggesting other factors are responsible for AF persistence.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>27780243</pmid><doi>10.1371/journal.pone.0164236</doi><tpages>e0164236</tpages><orcidid>https://orcid.org/0000-0001-8440-654X</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Ablation Ablation (Surgery) Action potential Aged Analysis Atrial fibrillation Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Biology and Life Sciences Cardiac arrhythmia Cardiology Catheter Ablation - methods Catheters Combined Modality Therapy Complexity Conduction Density Dynamic stability Electric properties Electrodes Epicardial Mapping - methods Female Fibrillation Heart Heart Atria - physiopathology Heart Atria - surgery Humans Male Mapping Mathematical analysis Mathematical models Medical instruments Medicine Medicine and Health Sciences Middle Aged Models, Theoretical Patients Phase coherence Pilot Projects Radiofrequency ablation Regularization Research and Analysis Methods Thoracic surgery Treatment Outcome Veins & arteries |
| title | Local Electrical Dyssynchrony during Atrial Fibrillation: Theoretical Considerations and Initial Catheter Ablation Results |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-31T22%3A19%3A11IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Local%20Electrical%20Dyssynchrony%20during%20Atrial%20Fibrillation:%20Theoretical%20Considerations%20and%20Initial%20Catheter%20Ablation%20Results&rft.jtitle=PloS%20one&rft.au=Kuklik,%20Pawel&rft.date=2016-10-25&rft.volume=11&rft.issue=10&rft.spage=e0164236&rft.epage=e0164236&rft.pages=e0164236-e0164236&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0164236&rft_dat=%3Cgale_plos_%3EA471904782%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1832215958&rft_id=info:pmid/27780243&rft_galeid=A471904782&rft_doaj_id=oai_doaj_org_article_c8f79dc679864f7f96d85deb7691ed93&rfr_iscdi=true |