This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Haïssaguerre, M. Articles by Jaïs, P. Search for Related Content PubMed PubMed Citation Articles by Haïssaguerre, M. Articles by Jaïs, P. Related Collections Electrophysiology Arrhythmias, clinical electrophysiology, drugs Ablation/ICD/surgery

(Circulation. 2006;113:616-625.)
© 2006 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Localized Sources Maintaining Atrial Fibrillation Organized by Prior Ablation

Michel Haïssaguerre, MD; Mélèze Hocini, MD; Prashanthan Sanders, MBBS, PhD; Yoshihide Takahashi, MD; Martin Rotter, MD; Frederic Sacher, MD; Thomas Rostock, MD; Li-Fern Hsu, MBBS; Anders Jonsson, MD; Mark D. O’Neill, MBChB, DPhil; Pierre Bordachar, MD; Sylvain Reuter, MD; Raymond Roudaut, MD; Jacques Clémenty, MD; Pierre Jaïs, MD

From the Hôpital Cardiologique du Haut-Lévêque and University Victor Segalen, Bordeaux, France.

Correspondence to Professor Michel Haïssaguerre, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux, France. E-mail jacques.clementy{at}pu.u-bordeaux2.fr

Received March 2, 2005; revision received November 10, 2005; accepted November 18, 2005.

Background— Endocardial mapping of localized sources driving atrial fibrillation (AF) in humans has not been reported.

Methods and Results— Fifty patients with AF organized by prior pulmonary vein and linear ablation were studied. AF was considered organized if mapping during AF showed irregular but discrete atrial complexes exhibiting consistent activation sequences for >75% of the time using a 20-pole catheter with 5 radiating spines covering 3.5-cm diameter or sequential conventional mapping. A site or region centrifugally activating the remaining atrial tissue defined a source. During AF with a cycle length of 211±32 ms, activation mapping identified 1 to 3 sources at the origin of atrial wavefronts in 38 patients (76%) predominantly in the left atrium, including the coronary sinus region. Electrograms at the earliest area varied from discrete centrifugal activation to an activity spanning 75% to 100% of the cycle length in 42% of cases, the latter indicating complex local conduction or a reentrant circuit. A gradient of cycle length (>20 ms) to the surrounding atrium was observed in 28%. Local radiofrequency ablation prolonged AF cycle length by 28±22 ms and either terminated AF or changed activation sequence to another organized rhythm. In 4 patients, the driving source was isolated, surrounded by the atrium in sinus rhythm, and still firing at high frequency (228±31 ms) either permanently or in bursts.

Conclusions— AF associated with consistent atrial activation sequences after prior ablation emanates mostly from localized sources that can be mapped and ablated. Some sources harbor electrograms suggesting the presence of localized reentry.

---

 

CLINICAL PERSPECTIVE

This article has been cited by other articles:

				S. Knecht, M. Hocini, M. Wright, N. Lellouche, M. D. O'Neill, S. Matsuo, I. Nault, V. S. Chauhan, K. J. Makati, M. Bevilacqua, et al. Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation Eur. Heart J., July 8, 2008; (2008) ehn302v1. [Abstract] [Full Text] [PDF]

				M. Haissaguerre, M. Wright, M. Hocini, and P. Jais The Substrate Maintaining Persistent Atrial Fibrillation Circ Arrhythmia Electrophysiol, April 1, 2008; 1(1): 2 - 5. [Full Text] [PDF]

				A. M. Patel, A. d'Avila, P. Neuzil, S. J. Kim, MSEE, T. Mela, J. P. Singh, J. N. Ruskin, and V. Y. Reddy Atrial Tachycardia After Ablation of Persistent Atrial Fibrillation: Identification of the Critical Isthmus With a Combination of Multielectrode Activation Mapping and Targeted Entrainment Mapping Circ Arrhythmia Electrophysiol, April 1, 2008; 1(1): 14 - 22. [Abstract] [Full Text] [PDF]

				N.-W. Hsu, Y.-J. Lin, C.-T. Tai, T. Kao, S.-L. Chang, W. Wongcharoen, L.-W. Lo, A. R. Udyavar, Y.-F. Hu, H.-W. Tso, et al. Frequency analysis of the fibrillatory activity from surface ECG lead V1 and intracardiac recordings: implications for mapping of AF Europace, April 1, 2008; 10(4): 438 - 443. [Abstract] [Full Text] [PDF]

				Y. Takahashi, M. D. O'Neill, M. Hocini, R. Dubois, S. Matsuo, S. Knecht, S. Mahapatra, K.-T. Lim, P. Jais, A. Jonsson, et al. Characterization of electrograms associated with termination of chronic atrial fibrillation by catheter ablation. J. Am. Coll. Cardiol., March 11, 2008; 51(10): 1003 - 1010. [Abstract] [Full Text] [PDF]

				R. Arora, J. S. Ulphani, R. Villuendas, J. Ng, L. Harvey, S. Thordson, F. Inderyas, Y. Lu, D. Gordon, P. Denes, et al. Neural substrate for atrial fibrillation: implications for targeted parasympathetic blockade in the posterior left atrium Am J Physiol Heart Circ Physiol, January 1, 2008; 294(1): H134 - H144. [Abstract] [Full Text] [PDF]

				E. Pruvot, F. Jousset, P. Ruchat, J.-M. Vesin, Y. Prudat, T. Zerm, and M. Fromer Propagation velocity kinetics and repolarization alternans in a free-behaving sheep model of pacing-induced atrial fibrillation Europace, November 1, 2007; 9(suppl_6): vi83 - vi88. [Abstract] [Full Text] [PDF]

				M. D. O'Neill, P. Jais, M. Hocini, F. Sacher, G. J. Klein, J. Clementy, and M. Haissaguerre Catheter Ablation for Atrial Fibrillation Circulation, September 25, 2007; 116(13): 1515 - 1523. [Full Text] [PDF]

				H. Calkins, J. Brugada, D. L. Packer, R. Cappato, S.-A. Chen, H. J.G. Crijns, R. J. Damiano Jr, D. W. Davies, D. E. Haines, M. Haissaguerre, et al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace, June 1, 2007; 9(6): 335 - 379. [Full Text] [PDF]

				M. M. Scheinman and E. Keung The Year in Clinical Cardiac Electrophysiology J. Am. Coll. Cardiol., May 22, 2007; 49(20): 2061 - 2069. [Full Text] [PDF]