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Panoramic characterization of endocardial left atrial activation during human persistent AF Insights from non-contact mapping.pdf
International Journal of Cardiology 228 (2017) 406–411
Contents lists available at ScienceDirect
International Journal of Cardiology
journal homepage: /locate/ijcard
Panoramic characterization of endocardial left atrial activation during human persistent AF: Insights from non-contact mapping
Geoffrey Lee a,b,1, Alex J.A. McLellan a, Ross J. Hunter a, Matthew J. Lovell a, Malcolm Finlay a, Waqas Ullah a,
Mehul B. Dhinoja a, Simon Sporton a, Mark J. Earley a, Richard J. Schilling a,?
a Cardiovascular Biomedical Research Unit, St Bartholomews Hospital, Barts Health NHS Trust, London, United Kingdom b The Department of Medicine, The University of Melbourne, Australia
article info
Article history: Received 29 July 2016 Accepted 5 November 2016 Available online 9 November 2016
Keywords: Atrial ?brillation Non-contact mapping Wavefront Electrogram Rotor
abstract
Background: The relative importance of focal drivers, multiple wavelets, rotors and endocardial–epicardial circuits in the maintenance of persistent AF remains unclear. Our objective was to characterize AF wavefront (WF) dynamics during persistent AF. Methods: The Ensite 3000 (St Jude Medical) non-contact mapping system was used to map the LA of 15 patients with persistent AF. Wavefronts were classi?ed into planar WFs, rotors or focal WFs. For each new WF the site of origin, the unipolar electrogram, and propagation patterns were determined. Results: AF was characterized by highly unstable patterns of activation with random combinations of 1–2 propagating planar wavefronts alternating with focal activations in a dynamic process. Stable reentry circuits and rotors were never seen. A total of 499 wavefront patterns were analyzed in this study (416 planar wavefronts and 83 focal wavefronts). In an individual patient planar WFs accounted for 67 ± 35% of activations with lifespans of 98 ± 86 ms. Focal activations accounted for 29.7 ± 33.5% of activations with lifespans of 76 ± 95 ms. The most common sites for new WF gen
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