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Spatial Relation Between Left Atrial Anatomical Contact Areas and Circular Activation in Persistent Atrial Fibrillation
Author(s) -
NAKAHARA SHIRO,
YAMAGUCHI TAKANORI,
HORI YUICHI,
ANJO NAOFUMI,
HAYASHI AKIKO,
KOBAYASHI SAYUKI,
KOMATSU TAKAAKI,
SAKAI YOSHIHIKO,
FUKUI AKIRA,
TSUCHIYA TAKESHI,
TAGUCHI ISAO
Publication year - 2016
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12907
Subject(s) - medicine , atrial fibrillation , cardiology , left atrium , p wave
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.