Complexity and Distribution of Drivers in Relation to Duration of Persistent Atrial Fibrillation
Han S Lim, Mélèze Hocini, Remi Dubois, Arnaud Denis, Nicolas Derval, Stephan Zellerhoff, Seigo Yamashita, Benjamin Berte, Saagar Mahida, Yuki Komatsu, Matthew Daly, Laurence Jesel, Carole Pomier, Valentin Meillet, Sana Amraoui, Ashok J Shah, Hubert Cochet, Frédéric Sacher, Pierre Jaïs, Michel Haïssaguerre, Han S Lim, Mélèze Hocini, Remi Dubois, Arnaud Denis, Nicolas Derval, Stephan Zellerhoff, Seigo Yamashita, Benjamin Berte, Saagar Mahida, Yuki Komatsu, Matthew Daly, Laurence Jesel, Carole Pomier, Valentin Meillet, Sana Amraoui, Ashok J Shah, Hubert Cochet, Frédéric Sacher, Pierre Jaïs, Michel Haïssaguerre
Abstract
Background: The underlying mechanisms sustaining human persistent atrial fibrillation (PsAF) is poorly understood.
Objectives: This study sought to investigate the complexity and distribution of AF drivers in PsAF of varying durations.
Methods: Of 135 consecutive patients with PsAF, 105 patients referred for de novo ablation of PsAF were prospectively recruited. Patients were divided into 3 groups according to AF duration: PsAF presenting in sinus rhythm (AF induced), PsAF <12 months, and PsAF >12 months. Patients wore a 252-electrode vest for body surface mapping. Localized drivers (re-entrant or focal) were identified using phase-mapping algorithms.
Results: In this patient cohort, the most prominent re-entrant driver regions included the pulmonary vein (PV) regions and inferoposterior left atrial wall. Focal drivers were observed in 1 or both PV regions in 75% of patients. Comparing between the 3 groups, with longer AF duration AF complexity increased, reflected by increased number of re-entrant rotations (p < 0.05), number of re-entrant rotations and focal events (p < 0.05), and number of regions harboring re-entrant (p < 0.01) and focal (p < 0.05) drivers. With increased AF duration, a higher proportion of patients had multiple extra-PV driver regions, specifically in the inferoposterior left atrium (p < 0.01), superior right atrium (p < 0.05), and inferior right atrium (p < 0.05). Procedural AF termination was achieved in 70% of patients, but decreased with longer AF duration.
Conclusions: The complexity of AF drivers increases with prolonged AF duration. Re-entrant and focal drivers are predominantly located in the PV antral and adjacent regions. However, with longer AF duration, multiple drivers are distributed at extra-PV sites. AF termination rate declines as patients progress to longstanding PsAF, underscoring the importance of early intervention.
Keywords: complexity; drivers; panoramic mapping; persistent atrial fibrillation.
Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed