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Chu GS, Li X, Stafford PJ, Vanheusden FJ, Salinet JL, Almeida TP, Dastagir N, Sandilands AJ, Kirchhof P, Schlindwein FS, Ng GA. Simultaneous Whole-Chamber Non-contact Mapping of Highest Dominant Frequency Sites During Persistent Atrial Fibrillation: A Prospective Ablation Study. Front Physiol 2022; 13:826449. [PMID: 35370796 PMCID: PMC8966840 DOI: 10.3389/fphys.2022.826449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/21/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose Sites of highest dominant frequency (HDF) are implicated by many proposed mechanisms underlying persistent atrial fibrillation (persAF). We hypothesized that prospectively identifying and ablating dynamic left atrial HDF sites would favorably impact the electrophysiological substrate of persAF. We aim to assess the feasibility of prospectively identifying HDF sites by global simultaneous left atrial mapping. Methods PersAF patients with no prior ablation history underwent global simultaneous left atrial non-contact mapping. 30 s of electrograms recorded during AF were exported into a bespoke MATLAB interface to identify HDF regions, which were then targeted for ablation, prior to pulmonary vein isolation. Following ablation of each region, change in AF cycle length (AFCL) was documented (≥ 10 ms considered significant). Baseline isopotential maps of ablated regions were retrospectively analyzed looking for rotors and focal activation or extinction events. Results A total of 51 HDF regions were identified and ablated in 10 patients (median DF 5.8Hz, range 4.4-7.1Hz). An increase in AFCL of was seen in 20 of the 51 regions (39%), including AF termination in 4 patients. 5 out of 10 patients (including the 4 patients where AF termination occurred with HDF-guided ablation) were free from AF recurrence at 1 year. The proportion of HDF occurrences in an ablated region was not associated with change in AFCL (τ = 0.11, p = 0.24). Regions where AFCL decreased by 10 ms or more (i.e., AF disorganization) after ablation also showed lowest baseline spectral organization (p < 0.033 for any comparison). Considering all ablated regions, the average proportion of HDF events which were also HRI events was 8.0 ± 13%. Focal activations predominated (537/1253 events) in the ablated regions on isopotential maps, were modestly associated with the proportion of HDF occurrences represented by the ablated region (Kendall's τ = 0.40, p < 0.0001), and very strongly associated with focal extinction events (τ = 0.79, p < 0.0001). Rotors were rare (4/1253 events). Conclusion Targeting dynamic HDF sites is feasible and can be efficacious, but lacks specificity in identifying relevant human persAF substrate. Spectral organization may have an adjunctive role in preventing unnecessary substrate ablation. Dynamic HDF sites are not associated with observable rotational activity on isopotential mapping, but epi-endocardial breakthroughs could be contributory.
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Affiliation(s)
- Gavin S. Chu
- Department of Cardiovascular Science, University of Leicester, Leicester, United Kingdom
- Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Xin Li
- Department of Cardiovascular Science, University of Leicester, Leicester, United Kingdom
- School of Engineering, University of Leicester, Leicester, United Kingdom
| | - Peter J. Stafford
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | | | - João L. Salinet
- Center for Engineering, Modeling and Applied Social Sciences, University Federal of ABC, Santo André, Brazil
| | - Tiago P. Almeida
- Department of Cardiovascular Science, University of Leicester, Leicester, United Kingdom
- School of Engineering, University of Leicester, Leicester, United Kingdom
| | - Nawshin Dastagir
- Department of International Foundation, Massey University, Auckland, New Zealand
| | - Alastair J. Sandilands
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Paulus Kirchhof
- University Heart and Vascular Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fernando S. Schlindwein
- School of Engineering, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - G. André Ng
- Department of Cardiovascular Science, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
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Ehnesh M, Li X, Almeida TP, Chu GS, Dastagir N, Stafford PJ, Ng GA, Schlindwein FS. Evaluating spatial disparities of rotor sites and high dominant frequency regions during catheter ablation for PersAF patients targeting high dominant frequency sites using non-contacting mapping. Front Physiol 2022; 13:946718. [PMID: 35991173 PMCID: PMC9389330 DOI: 10.3389/fphys.2022.946718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose: Several studies have emphasised the significance of high dominant frequency (HDF) and rotors in the perpetuation of AF. However, the co-localisation relationship between both attributes is not completely understood yet. In this study, we aim to evaluate the spatial distributions of HDF regions and rotor sites within the left atrium (LA) pre and post HDF-guided ablation in PersAF. Methods: This study involved 10 PersAF patients undergoing catheter ablation targeting HDF regions in the LA. 2048-channels of atrial electrograms (AEG) were collected pre- and post-ablation using a non-contact array (EnSite, Abbott). The dominant frequency (DF, 4-10 Hz) areas with DF within 0.25 Hz of the maximum out of the 2048 points were defined as "high" DF (HDF). Rotors were defined as PSs that last more than 100 ms and at a similar location through subsequent phase frames over time. Results: The results indicated an extremely poor spatial correlation between the HDF regions and sites of the rotors in pre-versus post-ablation cases for the non-terminated (pre: CORR; 0.05 ± 0.17. vs. post: CORR; -0.030 ± 0.19, and with terminated patients (pre: CORR; -0.016 ± 0.03. post: CORR; -0.022 ± 0.04). Rotors associated with AF terminations had a long-lasting life-span post-ablation (non-terminated vs. terminated 120.7 ± 6.5 ms vs. 139.9 ± 39.8 ms), high core velocity (1.35 ± 1.3 mm/ms vs. 1.32 ± 0.9 mm/ms), and were less meandering (3.4 ± 3.04 mm vs. 1.5 ± 1.2 mm). Although the results suggest a poor spatial overlapping between rotors' sites and sites of AFCL changes in terminated and non-terminated patients, a higher correlation was determined in terminated patients (spatial overlapping percentage pre: 25 ± 4.2% vs. 17 ± 3.8% vs. post: 8 ± 4.2% vs. 3.7 ± 1.7% p < 0.05, respectively). Conclusion: Using non-contact AEG, it was noted that the correlation is poor between the spatial distribution of HDF regions and sites of rotors. Rotors were longer-lasting, faster and more stationary in patients with AF termination post-ablation. Rotors sites demonstrated poor spatial overlapping with sites of AFCL changes that lead to AF termination.
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Affiliation(s)
- Mahmoud Ehnesh
- School of Engineering, University of Leicester, Leicester, United Kingdom
- *Correspondence: Mahmoud Ehnesh,
| | - Xin Li
- School of Engineering, University of Leicester, Leicester, United Kingdom
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom
| | - Tiago P. Almeida
- School of Engineering, University of Leicester, Leicester, United Kingdom
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom
| | - Gavin S. Chu
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
| | - Nawshin Dastagir
- Department of International Foundation, Massey University, Auckland, New Zealand
| | - Peter J. Stafford
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
| | - G. André Ng
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
| | - Fernando S. Schlindwein
- School of Engineering, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
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Investigational Anti-Atrial Fibrillation Pharmacology and Mechanisms by Which Antiarrhythmics Terminate the Arrhythmia: Where Are We in 2020? J Cardiovasc Pharmacol 2021; 76:492-505. [PMID: 33165131 PMCID: PMC7641178 DOI: 10.1097/fjc.0000000000000892] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Antiarrhythmic drugs remain the mainstay therapy for patients with atrial fibrillation (AF). A major disadvantage of the currently available anti-AF agents is the risk of induction of ventricular proarrhythmias. Aiming to reduce this risk, several atrial-specific or -selective ion channel block approaches have been introduced for AF suppression, but only the atrial-selective inhibition of the sodium channel has been demonstrated to be valid in both experimental and clinical studies. Among the other pharmacological anti-AF approaches, “upstream therapy” has been prominent but largely disappointing, and pulmonary delivery of anti-AF drugs seems to be promising. Major contradictions exist in the literature about the electrophysiological mechanisms of AF (ie, reentry or focal?) and the mechanisms by which anti-AF drugs terminate AF, making the search for novel anti-AF approaches largely empirical. Drug-induced termination of AF may or may not be associated with prolongation of the atrial effective refractory period. Anti-AF drug research has been largely based on the “suppress reentry” ideology; however, results of the AF mapping studies increasingly indicate that nonreentrant mechanism(s) plays an important role in the maintenance of AF. Also, the analysis of anti-AF drug-induced electrophysiological alterations during AF, conducted in the current study, leans toward the focal source as the prime mechanism of AF maintenance. More effort should be placed on the investigation of pharmacological suppression of the focal mechanisms.
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Choi YJ, Sohn JJ, Kwon S, Lee SR, Cha MJ, Choi EK, Kim HC, Oh S. Relationship between dominant frequency, organization index, and left atrial size in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:3159-3165. [PMID: 33091184 DOI: 10.1111/jce.14785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/04/2020] [Accepted: 10/18/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Frequency domain analysis is a methodology for quantifying the organization of atrial fibrillation (AF) pattern to understand the pathophysiology of the electrical mechanism. We aimed to investigate whether the dominant frequency (DF) and organization index (OI) can indicate left atrial (LA) dilatation in patients with AF. METHODS AND RESULTS This observational, retrospective, single-center cohort study assessed 100 patients with persistent AF. The study population was divided into two groups based on an anterior-posterior LA dimension (LAD of 50 mm) measured by transthoracic echocardiography. The groups were one-to-one propensity score-matched. Frequency domain analysis was performed using signals at leads II and V1 on surface electrocardiogram to calculate the DF and OI. In all patients, the DF was shown to have an inverse relationship with LAD (R = -.369, p < .001 in lead II; R = -.330, p = .001 in lead V1), while the OI was directly associated with LAD (R = .234, p = .190 in lead II; R = .283, p = .004 in lead V1). However, no significant relationship between the signal amplitude and LAD was observed. Compared to patients with LAD ≤ 50 mm, those with LAD > 50 mm had a lower DF (5.057 ± 0.740 vs. 4.542 ± 0.898, p = .002) and higher OI (0.261 ± 0.104 vs. 0.322 ± 0.116, p = .007) in lead V1. These findings were consistent with those found in lead II. CONCLUSION Patients with persistent AF and a larger LA size had a significantly higher OI and lower DF than those with a smaller LA size. Atrial electrical properties of structural remodeling are associated with increased organization of atrial signals.
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Affiliation(s)
- You-Jung Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jang J Sohn
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee C Kim
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Honarbakhsh S, Schilling RJ, Keating E, Finlay M, Hunter RJ. Drivers in AF colocate to sites of electrogram organization and rapidity: Potential synergy between spectral analysis and STAR mapping approaches in prioritizing drivers for ablation. J Cardiovasc Electrophysiol 2020; 31:1340-1349. [PMID: 32219906 DOI: 10.1111/jce.14456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/27/2020] [Accepted: 03/16/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Stochastic trajectory analysis of ranked signals (STAR) mapping has recently been used to ablate persistent atrial fibrillation (AF) with high rates of AF termination and long-term freedom from AF in small, single-arm studies. We hypothesized that rapidity and organization markers would correlate with early sites of activation (ESA). METHODS Patients undergoing persistent AF ablation as part of the STAR mapping study were included. Five-minute unipolar basket recordings used to create STAR maps were used to determine the minimum-cycle length (Min-CL) and CL variability (CLV) at each electrode to identify the site of the fastest Min-CL and lowest CLV across the left atrium (LA). The location of ESA targeted with ablation was compared with these sites. Dominant frequency was assessed at ESA and compared with that of neighboring electrodes to assess for regional gradients. RESULTS Thirty-two patients were included with 83 ESA ablated, with an ablation response at 73 sites (24 AF termination and 49 CL slowing ≥30 ms). Out of these, 54 (74.0%) and 56 (76.7%) colocated to sites of fastest Min-CL and lowest CLV, respectively. Regional CL and frequency gradients were demonstrable at majority of ESA. ESA colocating to sites of fastest Min-CL and lowest CLV were more likely to terminate AF with ablation (odds ratio, 34 and 29, respectively, P = .02). These showed a moderate sensitivity (74.0% Min-CL and 75.3% CLV) and specificity (66.7% Min-CL and 76.9% CLV) in predicting ESA with an ablation response. CONCLUSIONS ESA correlate with rapidity and organization markers. Further work is needed to clarify any role for spectral analysis in prioritizing driver ablation.
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Affiliation(s)
| | | | - Emily Keating
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,QUML
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Honarbakhsh S, Schilling RJ, Orini M, Providencia R, Keating E, Finlay M, Sporton S, Chow A, Earley MJ, Lambiase PD, Hunter RJ. Structural remodeling and conduction velocity dynamics in the human left atrium: Relationship with reentrant mechanisms sustaining atrial fibrillation. Heart Rhythm 2018; 16:18-25. [PMID: 30026014 PMCID: PMC6317307 DOI: 10.1016/j.hrthm.2018.07.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Indexed: 11/29/2022]
Abstract
Background Rate-dependent conduction velocity (CV) slowing is associated with atrial fibrillation (AF) initiation and reentrant mechanisms. Objective The purpose of this study was to assess the relationship between bipolar voltage, CV dynamics, and AF drivers. Methods Patients undergoing catheter ablation for persistent AF (<24 months) were enrolled. Unipolar electrograms were recorded with a 64-pole basket catheter during atrial pacing at 4 pacing intervals (PIs) during sinus rhythm. CVs were measured between pole pairs along the wavefront path and correlated with underlying bipolar voltage. CV dynamics within low-voltage zones (LVZs <0.5 mV) were compared to those of non-LVZs (≥0.5 mV) and were correlated to driver sites mapped using CARTOFINDER (Biosense Webster). Results Eighteen patients were included (age 62 ± 10 years). Mean CV at 600 ms was 1.59 ± 0.13 m/s in non-LVZs vs 0.98 ± 0.23 m/s in LVZs (P <.001). CV decreased incrementally over all 4 PIs in LVZs, whereas in non-LVZs a substantial decrease in CV was only seen between PIs 300–250 ms (0.59 ± 0.09 m/s; P <.001). Rate-dependent CV slowing sites measurements, defined as exhibiting CV reduction ≥20% more than the mean CV reduction seen between PIs 600–250 ms for that voltage zone, were predominantly in LVZs (0.2–0.5 mV; 75.6% ± 15.5%; P <.001). Confirmed rotational drivers were mapped to these sites in 94.1% of cases (sensitivity 94.1%, 95% CI 71.3%–99.9%; specificity 77.9%, 95% CI 74.9%–80.7%). Conclusion CV dynamics are determined largely by the extent of remodeling. Rate-dependent CV slowing sites are predominantly confined to LVZs (0.2–0.5 mV), and the resultant CV heterogeneity may promote driver formation in AF.
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Affiliation(s)
| | | | - Michele Orini
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Rui Providencia
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Emily Keating
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Simon Sporton
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Anthony Chow
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Mark J Earley
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
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Honarbakhsh S, Schilling RJ, Providencia R, Keating E, Chow A, Sporton S, Lowe M, Earley MJ, Lambiase PD, Hunter RJ. Characterization of drivers maintaining atrial fibrillation: Correlation with markers of rapidity and organization on spectral analysis. Heart Rhythm 2018; 15:1296-1303. [PMID: 29753943 DOI: 10.1016/j.hrthm.2018.04.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Better characterization of drivers in atrial fibrillation (AF) may facilitate their identification. OBJECTIVE The purpose of this study was to demonstrate that certain driver characteristics are associated with greater mechanistic importance in maintaining AF. METHODS Persistent AF was mapped in patients using the CARTOFINDER system with a 64-pole basket catheter to identify and ablate drivers with rotational or focal activity after pulmonary vein isolation. An ablation response was defined as cycle length (CL) slowing ≥30 ms or AF termination. Driver sites with an ablation response were correlated to sites of fastest CL, highest dominant frequency (DF), and greatest organization (lowest cycle length variability [CLV] and highest regularity index [RI]). Parameters predicting AF termination with driver ablation were evaluated. RESULTS All 29 patients had ≥1 driver identified. Forty-four potential drivers were identified. The predefined ablation response occurred with 39 drivers (89%): 23 rotational and 16 focal. During a 30-second recording, each driver occurred 8.7 ± 5.4 times and completed 3.1 ± 0.9 consecutive repetitions per occurrence. Driver sites correlated best with markers of organization, corresponding to the site of lowest CLV (29/39 [74%]) and highest RI (26/39 [67%]). Correlation with sites of fastest CL and highest DF was poor (17/39 and 15/39, respectively) and depended on driver temporal stability. Greater temporal stability (3.4 ± 0.9 vs 2.7 ± 0.6; P = .001) and driver correlation with sites of lowest CLV and highest RI (both P <.001) predicted AF termination with ablation. CONCLUSION Intermittent focal or rotational drivers were identified in all patients. Drivers consistently correlated to organization markers. Greater temporal stability and organization predicted AF termination with driver ablation.
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Affiliation(s)
- Shohreh Honarbakhsh
- Barts Heart Centre, Barts Health NHS Trust, Department of Arrhythmia Management, London, United Kingdom
| | - Richard J Schilling
- Barts Heart Centre, Barts Health NHS Trust, Department of Arrhythmia Management, London, United Kingdom
| | - Rui Providencia
- Barts Heart Centre, Barts Health NHS Trust, Department of Arrhythmia Management, London, United Kingdom
| | - Emily Keating
- Barts Heart Centre, Barts Health NHS Trust, Department of Arrhythmia Management, London, United Kingdom
| | - Anthony Chow
- Barts Heart Centre, Barts Health NHS Trust, Department of Arrhythmia Management, London, United Kingdom
| | - Simon Sporton
- Barts Heart Centre, Barts Health NHS Trust, Department of Arrhythmia Management, London, United Kingdom
| | - Martin Lowe
- Barts Heart Centre, Barts Health NHS Trust, Department of Arrhythmia Management, London, United Kingdom
| | - Mark J Earley
- Barts Heart Centre, Barts Health NHS Trust, Department of Arrhythmia Management, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, Department of Arrhythmia Management, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre, Barts Health NHS Trust, Department of Arrhythmia Management, London, United Kingdom.
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Modeling Atrial Fibrillation using Human Embryonic Stem Cell-Derived Atrial Tissue. Sci Rep 2017; 7:5268. [PMID: 28706272 PMCID: PMC5509676 DOI: 10.1038/s41598-017-05652-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/01/2017] [Indexed: 12/31/2022] Open
Abstract
Since current experimental models of Atrial Fibrillation (AF) have significant limitations, we used human embryonic stem cells (hESCs) to generate an atrial-specific tissue model of AF for pharmacologic testing. We generated atrial-like cardiomyocytes (CMs) from hESCs which preferentially expressed atrial-specific genes, and had shorter action potential (AP) durations compared to ventricular-like CMs. We then generated confluent atrial-like CM sheets and interrogated them using optical mapping techniques. Atrial-like CM sheets (~1 cm in diameter) showed uniform AP propagation, and rapid re-entrant rotor patterns, as seen in AF could be induced. Anti-arrhythmic drugs were tested on single atrial-like CMs and cell sheets. Flecainide profoundly slowed upstroke velocity without affecting AP duration, leading to reduced conduction velocities (CVs), curvatures and cycle lengths of rotors, consistent with increased rotor organization and expansion. By contrast, consistent with block of rapid delayed rectifier K+ currents (Ikr) and AP prolongation in isolated atrial-like CMs, dofetilide prolonged APs and reduced cycle lengths of rotors in cell sheets without affecting CV. In conclusion, using our hESC-derived atrial CM preparations, we demonstrate that flecainide and dofetilide modulate reentrant arrhythmogenic rotor activation patterns in a manner that helps explain their efficacy in treating and preventing AF.
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Li X, Salinet JL, Almeida TP, Vanheusden FJ, Chu GS, Ng GA, Schlindwein FS. An interactive platform to guide catheter ablation in human persistent atrial fibrillation using dominant frequency, organization and phase mapping. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 141:83-92. [PMID: 28241971 DOI: 10.1016/j.cmpb.2017.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/05/2017] [Accepted: 01/17/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Optimal targets for persistent atrial fibrillation (persAF) ablation are still debated. Atrial regions hosting high dominant frequency (HDF) are believed to participate in the initiation and maintenance of persAF and hence are potential targets for ablation, while rotor ablation has shown promising initial results. Currently, no commercially available system offers the capability to automatically identify both these phenomena. This paper describes an integrated 3D software platform combining the mapping of both frequency spectrum and phase from atrial electrograms (AEGs) to help guide persAF ablation in clinical cardiac electrophysiological studies. METHODS 30s of 2048 non-contact AEGs (EnSite Array, St. Jude Medical) were collected and analyzed per patient. After QRST removal, the AEGs were divided into 4s windows with a 50% overlap. Fast Fourier transform was used for DF identification. HDF areas were identified as the maximum DF to 0.25Hz below that, and their centers of gravity (CGs) were used to track their spatiotemporal movement. Spectral organization measurements were estimated. Hilbert transform was used to calculate instantaneous phase. RESULTS The system was successfully used to guide catheter ablation for 10 persAF patients. The mean processing time was 10.4 ± 1.5min, which is adequate comparing to the normal electrophysiological (EP) procedure time (120∼180min). CONCLUSIONS A customized software platform capable of measuring different forms of spatiotemporal AEG analysis was implemented and used in clinical environment to guide persAF ablation. The modular nature of the platform will help electrophysiological studies in understanding of the underlying AF mechanisms.
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Affiliation(s)
- Xin Li
- Department of Engineering, University of Leicester, UK; Department of Cardiovascular Science, University of Leicester, UK
| | - João L Salinet
- Biomedical Engineering, Center for Engineering, Modelling and Applied Social Sciences, Universidade Federal do ABC, Brazil; Bioengineering Division, Heart Institute (InCor), Brasil
| | - Tiago P Almeida
- Department of Engineering, University of Leicester, UK; Biomedical Engineering, Center for Engineering, Modelling and Applied Social Sciences, Universidade Federal do ABC, Brazil
| | | | - Gavin S Chu
- Department of Cardiovascular Science, University of Leicester, UK; University Hospitals of Leicester NHS Trust, UK
| | - G André Ng
- Department of Cardiovascular Science, University of Leicester, UK; University Hospitals of Leicester NHS Trust, UK; National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, UK
| | - Fernando S Schlindwein
- Department of Engineering, University of Leicester, UK; National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, UK.
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Stavrakis S, Dyer JW, Koomson E, Scherlag BJ, Bhardwaj B, Lazzara R, Po SS. Spectral Analysis of Baseline Electrocardiogram During Atrial Fibrillation Predicts Response to Antiarrhythmic Drug Therapy in Patients With Persistent Atrial Fibrillation. J Cardiovasc Electrophysiol 2016; 27:1312-1318. [PMID: 27506321 DOI: 10.1111/jce.13064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/28/2016] [Accepted: 08/02/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND We evaluated the ability of spectral analysis of the baseline ECG during atrial fibrillation (AF) to predict the response of persistent AF to antiarrhythmic drug therapy. METHODS Patients with persistent AF who were admitted for dofetilide loading were prospectively enrolled in the study. Atrial activity was extracted from the ECG using an Independent Component Analysis method and then subjected to a Modified Periodogram. The regularity index was computed as the ratio of the power in the dominant frequency and all its harmonics to the total power in the spectrum. Patients were followed at 1 month, 3 months and every 3 months thereafter. RESULTS Of 28 patients enrolled in the study, 14 (50%) converted acutely to sinus rhythm during the 3-day hospital loading period. The clinical and echocardiographic characteristics of patients with and without acute pharmacologic conversion were similar. The regularity index was significantly higher in those who converted to sinus rhythm compared to those who did not (0.71 ± 0.20 vs. 0.38 ± 0.13, respectively; P < 0.0001). A regularity index ≥0.44 had a 79% sensitivity and 93% specificity to predict acute conversion and was associated with a nearly 5-fold increase in the acute conversion rate (odds ratio = 4.89; 95% confidence interval 1.74-13.75; P = 0.003). The regularity index was the only independent predictor of acute conversion. Neither acute conversion, nor the regularity index predicted sinus rhythm maintenance, after a median follow-up of 10 months. CONCLUSION Increased regularity index predicts acute conversion of persistent AF during dofetilide loading, but does not predict long-term sinus rhythm maintenance.
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Affiliation(s)
- Stavros Stavrakis
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - John W Dyer
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Edward Koomson
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Benjamin J Scherlag
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Bhaskar Bhardwaj
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ralph Lazzara
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Sunny S Po
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Stavrakis S, Dyer JW, Scherlag BJ, Khan Z, Yeung P, Chohan J, Po SS. Spectral Analysis of Electrocardiograms in Patients with Inducible Atrial Fibrillation after Catheter Ablation Predicts Sinus Rhythm Maintenance. Ann Noninvasive Electrocardiol 2016; 22. [PMID: 27226336 DOI: 10.1111/anec.12369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND We aimed to develop a novel predictive marker for atrial fibrillation (AF) recurrence in patients with inducible AF after catheter ablation, based on power spectral analysis of baseline and postablation electrocardiograms. METHODS Twenty-five patients who had undergone their first AF ablation procedure (pulmonary vein isolation and ganglionated plexi ablation) and had inducible AF after ablation were included. A 30-second interval of AF was chosen for each patient before and after ablation, and a periodogram of the atrial activity was computed. A ratio of the power in the dominant frequency to the power in the remainder of the periodogram (DFR) was calculated. RESULTS Eight (32%) patients had recurrent AF at 1 year. The clinical and echocardiographic characteristics of patients with and without recurrence were similar (P > 0.05). After ablation, there was organization of atrial activity, evidenced by an increase in the DFR (0.28 ± 0.22 vs 0.53 ± 0.29; P = 0.001). The percent change in DFR before and after ablation (median [interquartile range]) was significantly higher in patients without AF recurrence (120% [30% to 344%] vs 3% [-27% to 66%]; P = 0.01). Receiver operating curve (ROC) analysis demonstrated that a less than 16% increase in DFR postablation was able to predict recurrence of AF (area under ROC curve = 0.82; P = 0.03) with 75% sensitivity and 94% specificity. CONCLUSION AF ablation leads to variable organization of atrial activity. Organization of atrial activity after AF ablation is associated with lower 1-year recurrence rates and may be used intraprocedurally after as a novel end point for AF ablation. Larger prospective studies are warranted.
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Affiliation(s)
- Stavros Stavrakis
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - John W Dyer
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Benjamin J Scherlag
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zeeshan Khan
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Paul Yeung
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jawad Chohan
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sunny S Po
- Department of Medicine and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Lim HS, Derval N, Komatsu Y, Zellerhoff S, Denis A, Shah AJ, Sacher F, Hocini M, Jaïs P, Haïssaguerre M. Is Ablation to Termination the Best Strategy for Ablation of Persistent Atrial Fibrillation? Circ Arrhythm Electrophysiol 2015; 8:963-71. [DOI: 10.1161/circep.114.001721] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Han S. Lim
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Nicolas Derval
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Yuki Komatsu
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Stephan Zellerhoff
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Arnaud Denis
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Ashok J. Shah
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Frédéric Sacher
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Mélèze Hocini
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Pierre Jaïs
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Michel Haïssaguerre
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
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13
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Biviano AB, Ciaccio EJ, Knotts R, Fleitman J, Lawrence J, Iyer V, Whang W, Garan H. Atrial electrogram discordance during baseline vs reinduced atrial fibrillation: Potential ramifications for ablation procedures. Heart Rhythm 2015; 12:1448-55. [PMID: 25818256 PMCID: PMC4485587 DOI: 10.1016/j.hrthm.2015.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND There are scant data comparing the electrogram (EGM) signal characteristics of atrial fibrillation (AF) at baseline vs electrically induced states during ablation procedures. OBJECTIVE The purpose of this study was to use novel intracardiac signal analysis techniques to gain insights into the effects of catheter ablation and AF reinduction on AF EGMs in patients with persistent AF. METHODS We collected left atrial EGMs in patients undergoing first ablation for persistent AF at 3 time intervals: (1) AF at baseline; (2) AF after pulmonary vein isolation (PVI); and (3) AF after post-PVI cardioversion and subsequent reinduction. We analyzed 2 EGM spectral characteristics: (1) dominant frequency and (2) spectral complexity; and 2 EGM morphologic characteristics: (1) morphology variation and (2) pattern repetitiveness. RESULTS There were no differences in AF dominant frequency, dominant amplitude, spectral complexity, or metrics of EGM morphology or repetitiveness at baseline vs after PVI. However, dominant frequency, dominant amplitude, and spectral complexity differed significantly after direct current cardioversion and reinduction of AF. CONCLUSION The frequency, spectral complexity, and local EGM morphologies of AF do not significantly change over the course of a PVI procedure in patients with persistent AF. However, reinduction of AF after direct current cardioversion results in different dominant frequency and spectral complexity, consistent with a change in the characteristics of the perpetuating source(s) of the newly induced AF. These data suggest that AF properties can vary significantly between baseline and reinduced AF, with potential clinical ramifications for outcomes of catheter ablation procedures.
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Affiliation(s)
- Angelo B Biviano
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York.
| | - Edward J Ciaccio
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York
| | - Robert Knotts
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jessica Fleitman
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York
| | - John Lawrence
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York
| | - Vivek Iyer
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York
| | - William Whang
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York
| | - Hasan Garan
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York
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14
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Haugaard MM, Pehrson S, Carstensen H, Flethøj M, Hesselkilde EZ, Praestegaard KF, Diness JG, Grunnet M, Jespersen T, Buhl R. Antiarrhythmic and electrophysiologic effects of flecainide on acutely induced atrial fibrillation in healthy horses. J Vet Intern Med 2014; 29:339-47. [PMID: 25328012 PMCID: PMC4858114 DOI: 10.1111/jvim.12496] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 09/02/2014] [Accepted: 10/02/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Only few pharmacologic compounds have been validated for treatment of atrial fibrillation (AF) in horses. Studies investigating the utility and safety of flecainide to treat AF in horses have produced conflicting results, and the antiarrhythmic mechanisms of flecainide are not fully understood. OBJECTIVES To study the potential of flecainide to terminate acutely induced AF of short duration (≥ 15 minutes), to examine flecainide-induced changes in AF duration and AF vulnerability, and to investigate the in vivo effects of flecainide on right atrial effective refractory period, AF cycle length, and ventricular depolarization and repolarization. ANIMALS Nine Standardbred horses. Eight received flecainide, 3 were used as time-matched controls, 2 of which also received flecainide. METHODS Prospective study. The antiarrhythmic and electrophysiologic effects of flecainide were based on 5 parameters: ability to terminate acute pacing-induced AF (≥ 15 minutes), and drug-induced changes in atrial effective refractory period, AF duration, AF vulnerability, and ventricular depolarization and repolarization times. Parameters were assessed at baseline and after flecainide by programmed electrical stimulation methods. RESULTS Flecainide terminated all acutely induced AF episodes (n = 7); (AF duration, 21 ± 5 minutes) and significantly decreased the AF duration, but neither altered atrial effective refractory period nor AF vulnerability significantly. Ventricular repolarization time was prolonged between 8 and 20 minutes after initiation of flecainide infusion, but no ventricular arrhythmias were detected. CONCLUSIONS AND CLINICAL IMPORTANCE Flecainide had clear antiarrhythmic properties in terminating acute pacing-induced AF, but showed no protective properties against immediate reinduction of AF. Flecainide caused temporary prolongation in the ventricular repolarization, which may be a proarrhythmic effect.
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Affiliation(s)
- M M Haugaard
- Department of Large Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
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Aunes M, Egstrup K, Frison L, Berggren A, Stridh M, Sörnmo L, Edvardsson N. Rapid slowing of the atrial fibrillatory rate after administration of AZD7009 predicts conversion of atrial fibrillation. J Electrocardiol 2013; 47:316-23. [PMID: 24508473 DOI: 10.1016/j.jelectrocard.2013.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Effects on the atrial fibrillatory rate (AFR) were studied during infusion with the combined potassium and sodium channel blocker AZD7009. METHODS AND RESULTS Patients with persistent atrial fibrillation (AF) were randomized to AZD7009 or placebo. Thirty-five patients converted to sinus rhythm (SR) and were matched to 35 non-converters. The mean AFR before conversion was 231 fibrillations per minute (fpm), having decreased by 41%; in non-converters, it was 296 fpm at the end of infusion, having decreased by 26%. The rate of decrease was greater in converters at 5 min, -88 vs. -66 fpm (p=0.02), and at 10 min, -133 vs. -111 fpm (p=0.048). The AFR-SD and the exponential decay decreased. A small left atrial area was the only baseline predictor of conversion to SR. CONCLUSIONS AZD7009 produced a significantly more rapid decrease of the AFR in converters than in non-converters, but the AFR at baseline was not predictive of conversion.
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Affiliation(s)
| | | | | | | | - Martin Stridh
- Department of Electrical and Information Technology and Center for Integrative Electrocardiology, Lund University, Lund, Sweden
| | - Leif Sörnmo
- Department of Electrical and Information Technology and Center for Integrative Electrocardiology, Lund University, Lund, Sweden
| | - Nils Edvardsson
- Sahlgrenska Academy at the Sahlgrenska University Hospital, Göteborg, Sweden
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16
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Biviano AB, Ciaccio EJ, Gabelman T, Whang W, Garan H. Ibutilide increases the variability and complexity of atrial fibrillation electrograms: antiarrhythmic insights using signal analyses. Pacing Clin Electrophysiol 2013; 36:1228-35. [PMID: 23875908 DOI: 10.1111/pace.12224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 05/06/2013] [Accepted: 06/03/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Intravenous ibutilide is used to convert atrial fibrillation (AF) to sinus rhythm (SR) due to its Class III antiarrhythmic mechanisms. However, the effects of ibutilide on local electrograms (EGMs) during AF have not been elucidated. METHODS AND RESULTS We used EGM analysis techniques to characterize how ibutilide administration changes the frequency, morphology, and repeatability of AF EGM signals, thereby providing insight into ibutilide's antiarrhythmic mechanism of action. AF recordings were collected from 21 patients with AF, both before and after ibutilide administration. The effects of ibutilide on the following AF EGM parameters were assessed: (1) dominant frequency (DF), (2) variations in EGM amplitude and overall morphology, (3) repetition of EGM patterns, and (4) complexity of the AF frequency spectra. When comparing pre- versus post-ibutilide administration EGMs, DF decreased from 5.45 Hz to 4.02 Hz (P < 0.0001). There was an increase in the variability of both AF EGM amplitudes (P = 0.003) and overall AF EGM morphologies (P = 0.003). AF EGM pattern repetitiveness decreased (P = 0.01), and the AF frequency spectral profile manifested greater complexity (P = 0.02). CONCLUSIONS Novel EGM signal analysis techniques reveal that ibutilide administration causes increased complexity in the atrial electrical activation pattern with decreasing rate. These findings may be explained by the progressive destabilization of higher frequency, more homogeneous primary drivers of AF over the course of ibutilide administration, and/or less uniform propagation of atrial activation, until AF maintenance becomes more difficult and either transforms to atrial tachycardia or terminates to SR.
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Affiliation(s)
- Angelo B Biviano
- Cardiology Division, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Newyork-Presbyterian Hospital, Columbia University Medical Center, New York, New York
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17
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Nagashima K, Okumura Y, Watanabe I, Nakai T, Ohkubo K, Kofune T, Kofune M, Mano H, Sonoda K, Hirayama A. Effects of inter-electrode spacing on complex fractionated atrial electrograms and dominant frequency detection. J Interv Card Electrophysiol 2012; 34:51-7. [DOI: 10.1007/s10840-011-9654-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
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18
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Tuan J, Jeilan M, Kundu S, Nicolson W, Chung I, Stafford PJ, Ng GA. Regional fractionation and dominant frequency in persistent atrial fibrillation: effects of left atrial ablation and evidence of spatial relationship. Europace 2011; 13:1550-6. [DOI: 10.1093/europace/eur174] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Workman AJ, Smith GL, Rankin AC. Mechanisms of termination and prevention of atrial fibrillation by drug therapy. Pharmacol Ther 2011; 131:221-41. [PMID: 21334377 DOI: 10.1016/j.pharmthera.2011.02.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 02/09/2011] [Indexed: 01/13/2023]
Abstract
Atrial fibrillation (AF) is a disorder of the rhythm of electrical activation of the cardiac atria. It is the most common cardiac arrhythmia, has multiple aetiologies, and increases the risk of death from stroke. Pharmacological therapy is the mainstay of treatment for AF, but currently available anti-arrhythmic drugs have limited efficacy and safety. An improved understanding of how anti-arrhythmic drugs affect the electrophysiological mechanisms of AF initiation and maintenance, in the setting of the different cardiac diseases that predispose to AF, is therefore required. A variety of animal models of AF has been developed, to represent and control the pathophysiological causes and risk factors of AF, and to permit the measurement of detailed and invasive parameters relating to the associated electrophysiological mechanisms of AF. The purpose of this review is to examine, consolidate and compare available relevant data on in-vivo electrophysiological mechanisms of AF suppression by currently approved and investigational anti-arrhythmic drugs in such models. These include the Vaughan Williams class I-IV drugs, namely Na(+) channel blockers, β-adrenoceptor antagonists, action potential prolonging drugs, and Ca(2+) channel blockers; the "upstream therapies", e.g., angiotensin converting enzyme inhibitors, statins and fish oils; and a variety of investigational drugs such as "atrial-selective" multiple ion channel blockers, gap junction-enhancers, and intracellular Ca(2+)-handling modulators. It is hoped that this will help to clarify the main electrophysiological mechanisms of action of different and related drug types in different disease settings, and the likely clinical significance and potential future exploitation of such mechanisms.
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Affiliation(s)
- A J Workman
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, United Kingdom.
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Hunter RJ, Schilling RJ. Termination of atrial fibrillation by flecainide: mechanistic insights from spectral analysis. Europace 2010; 12:453-4. [DOI: 10.1093/europace/euq011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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