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Termination of persistent atrial fibrillation by ablating sites that control large atrial areas. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology Bhatia, N. K., Rogers, A. J., Krummen, D. E., Hossainy, S. n., Sauer, W. n., Miller, J. M., Alhusseini, M. I., Peszek, A. n., Armenia, E. n., Baykaner, T. n., Brachmann, J. n., Turakhia, M. P., Clopton, P. n., Wang, P. J., Rappel, W. J., Narayan, S. M. 2020

Abstract

Persistent atrial fibrillation (AF) has been explained by multiple mechanisms which, while they conflict, all agree that more disorganized AF is more difficult to treat than organized AF. We hypothesized that persistent AF consists of interacting organized areas which may enlarge, shrink or coalesce, and that patients whose AF areas enlarge by ablation are more likely to respond to therapy.We mapped vectorial propagation in persistent AF using wavefront fields (WFF), constructed from raw unipolar electrograms at 64-pole basket catheters, during ablation until termination (Group 1, N?=?20 patients) or cardioversion (Group 2, N?=?20 patients). Wavefront field mapping of patients (age 61.1?±?13.2 years, left atrium 47.1?±?6.9?mm) at baseline showed 4.6?±?1.0 organized areas, each separated by disorganization. Ablation of sites that led to termination controlled larger organized area than competing sites (44.1?±?11.1% vs. 22.4?±?7.0%, P?

View details for DOI 10.1093/europace/euaa018

View details for PubMedID 32243508