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- Title
Spatial Relation Between Left Atrial Anatomical Contact Areas and Circular Activation in Persistent Atrial Fibrillation.
- Authors
NAKAHARA, SHIRO; YAMAGUCHI, TAKANORI; HORI, YUICHI; ANJO, NAOFUMI; HAYASHI, AKIKO; KOBAYASHI, SAYUKI; KOMATSU, TAKAAKI; SAKAI, YOSHIHIKO; FUKUI, AKIRA; TSUCHIYA, TAKESHI; TAGUCHI, ISAO
- Abstract
Atrial Anatomical Contact Area and Circular Activation Introduction Atrial low-voltage zones (LVZs) may be related to maintenance of atrial fibrillation (AF). The influence of left atrial (LA) contact areas (CoAs) on reentrant or rotor-like sources maintaining AF has not been investigated. Methods and Results Forty patients with persistent AF (PsAF) were analyzed. Three representative CoA regions in the LA (ascending aorta: anterior wall; descending aorta: left inferior pulmonary vein; and vertebrae: posterior wall) were visualized by enhanced CT. Using circular catheters, the LVZs (<0.5 mV) were assessed after restoration of SR, and local activation mapping and frequency domain analyses were performed after induction of AF. Circular activation during AF was visually defined as sites with ≥2 rotations by serial electrograms encompassing >80% of the mean AF cycle length. A pivot was defined as the core of the localized circular activation. Anterior (39/40 patients, 98%), left pulmonary vein antrum (27/40, 68%), and posterior (19/40, 48%) CoAs were identified, and 80% (68/85) of those sites were overlapped by or close (<3 mm) to LVZs. Thirty-six (90%) patients demonstrated circular activation (3.1±1.7 sites/patients) along with significantly higher organized dominant frequencies (6.3 ± 0.5 Hz, regularity-index: 0.26 [0.23-0.41]) within the LA, and the average electrogram amplitude of those pivots was 0.30 mV (0.18-0.52). Of those sites, 55% (66/120) were located at or close to CoA regions. Catheter ablation including of LVZs neighboring CoAs terminated AF in 9 (23%) patients. Conclusions External anatomical structures contacting the LA may be related to unique conduction properties in diseased myocardium necessary for PsAF maintenance.
- Subjects
LEFT heart atrium; ANALYSIS of variance; ATRIAL fibrillation; COMPUTED tomography; CONFIDENCE intervals; STATISTICAL correlation; RESEARCH evaluation; T-test (Statistics); INTER-observer reliability; RETROSPECTIVE studies; DATA analysis software; DESCRIPTIVE statistics; MANN Whitney U Test; ANATOMY
- Publication
Journal of Cardiovascular Electrophysiology, 2016, Vol 27, Issue 5, p515
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/jce.12907