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rotor ablation atrial fibrillation

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https://www.readbyqxmd.com/read/29097406/localized-optogenetic-targeting-of-rotors-in-atrial-cardiomyocyte-monolayers
#1
Iolanda Feola, Linda Volkers, Rupamanjari Majumder, Alexander Teplenin, Martin J Schalij, Alexander V Panfilov, Antoine A F de Vries, Daniël A Pijnappels
BACKGROUND: Recently, a new ablation strategy for atrial fibrillation has emerged, which involves the identification of rotors (ie, local drivers) followed by the localized targeting of their core region by ablation. However, this concept has been subject to debate because the mode of arrhythmia termination remains poorly understood, as dedicated models and research tools are lacking. We took a unique optogenetic approach to induce and locally target a rotor in atrial monolayers. METHODS AND RESULTS: Neonatal rat atrial cardiomyocyte monolayers expressing a depolarizing light-gated ion channel (Ca(2+)-translocating channelrhodopsin) were subjected to patterned illumination to induce single, stable, and centralized rotors by optical S1-S2 cross-field stimulation...
November 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/29035207/novel-quantitative-analytical-approaches-for-rotor-identification-and-associated-implications-for-mapping
#2
Elizabeth M Annoni, Shivaram Poigai Arunachalam, Suraj Kapa, Siva K Mulpuru, Paul A Friedman, Elena G Talkachova
OBJECTIVE: Clinical studies identifying rotors confirming these sites for ablation in treating cardiac arrhythmias have had inconsistent results with the current analysis techniques available. The aim of this study is to evaluate four new signal analysis approaches - multiscale frequency (MSF), Shannon entropy (SE), Kurtosis (Kt), and multiscale entropy (MSE) - in their ability to identify the pivot point of rotors. METHODS: Optical mapping movies of ventricular tachycardia were used to evaluate the performance and robustness of SE, Kt, MSF and MSE techniques with respect to several clinical limitations: decreased time duration, reduced spatial resolution, and the presence of meandering rotors...
October 16, 2017: IEEE Transactions on Bio-medical Engineering
https://www.readbyqxmd.com/read/29016785/obstructive-sleep-apnea-is-associated-with-increased-rotor-burden-in-patients-undergoing-focal-impulse-and-rotor-modification-guided-atrial-fibrillation-ablation
#3
Daniel J Friedman, Peter Liu, Adam S Barnett, Kristen Bova Campbell, Kevin P Jackson, Tristram D Bahnson, James P Daubert, Jonathan P Piccini
Aims: To assess whether obstructive sleep apnea (OSA) was associated with increased rotor burden among atrial fibrillation (AF) patients. Methods and results: We studied 33 consecutive patients who were scheduled for focal impulse and rotor modulation (FIRM) ablation at our institution to describe the mapping, ablation, and outcomes, among patients with and without OSA. Patients underwent biatrial FIRM mapping in AF with ablation of stable rotors in addition to conventional ablation lesion sets...
August 9, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28988690/impact-of-number-of-co-existing-rotors-and-inter-electrode-distance-on-accuracy-of-rotor-localization
#4
Konstantinos N Aronis, Hiroshi Ashikaga
BACKGROUND: Conflicting evidence exists on the efficacy of focal impulse and rotor modulation on atrial fibrillation ablation. A potential explanation is inaccurate rotor localization from multiple rotors coexistence and a relatively large (9-11mm) inter-electrode distance (IED) of the multi-electrode basket catheter. METHODS AND RESULTS: We studied a numerical model of cardiac action potential to reproduce one through seven rotors in a two-dimensional lattice. We estimated rotor location using phase singularity, Shannon entropy and dominant frequency...
September 1, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28964155/demonstration-of-cardiac-rotor-and-source-mapping-techniques-in-embryonic-chick-monolayers
#5
Min Ju You, Peter Langfield, Lucas Campanari, Matt Dobbs, Alvin Shrier, Leon Glass
Excitable media, such as the heart, display propagating waves with different geometries including target patterns and rotors (spiral waves). Collision of two waves leads to annihilation of both. We present algorithms for data processing and analysis to identify the core of rotors. In this work, we show that as the spatial sampling resolution decreases it becomes increasingly difficult to identify rotors-there are instances of false negatives and false positives. These observations are relevant to current controversies concerning the role of rotors in the initiation, maintenance, and treatment of cardiac arrhythmias, especially atrial fibrillation...
September 2017: Chaos
https://www.readbyqxmd.com/read/28887361/technical-considerations-on-phase-mapping-for-identification-of-atrial-reentrant-activity-in-direct-and-inverse-computed-electrograms
#6
Miguel Rodrigo, Andreu M Climent, Alejandro Liberos, Francisco Fernández-Avilés, Omer Berenfeld, Felipe Atienza, Maria S Guillem
BACKGROUND: Phase mapping has become a broadly used technique to identify atrial reentrant circuits for ablative therapy guidance. This work studies the phase mapping process and how the signal nature and its filtering affect the reentrant pattern characterization in electrogram (EGM), body surface potential mapping, and electrocardiographic imaging signals. METHODS AND RESULTS: EGM, body surface potential mapping, and electrocardiographic imaging phase maps were obtained from 17 simulations of atrial fibrillation, atrial flutter, and focal atrial tachycardia...
September 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/28856145/ablation-of-long-standing-persistent-atrial-fibrillation
#7
REVIEW
Behram P Mody, Anoshia Raza, Jason Jacobson, Sei Iwai, Daniel Frenkel, Rhadames Rojas, Wilbert S Aronow
Atrial fibrillation (AF) is the most commonly encountered arrhythmia in the clinical setting affecting nearly 6 million people in United States and the numbers are only expected to rise as the population continues to age. Broadly it is classified into paroxysmal, persistent and longstanding persistent AF. Electrical, structural and autonomic remodeling are some of the diverse pathophysiological mechanisms that contribute to the persistence of AF. Our review article emphasizes particularly on long standing persistent atrial fibrillation (LSPAF) aspect of the disease which poses a great challenge for electrophysiologists...
August 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28827810/role-of-atrial-wall-thickness-in-wave-dynamics-of-atrial-fibrillation
#8
Jun-Seop Song, Jin Wi, Hye-Jeong Lee, Minki Hwang, Byounghyun Lim, Tae-Hoon Kim, Jae-Sun Uhm, Boyoung Joung, Moon-Hyoung Lee, Jeong-Wook Seo, Hui-Nam Pak
BACKGROUND/AIMS: Atrial anatomy and thickness may affect the electrical wave-dynamics of atrial fibrillation (AF). We explored the relationship between left atrial (LA) wall thickness (LAWT) or LA geometry and AF wave-dynamics. METHODS: We included 15 patients with persistent AF (age, 62.3 ± 11.9 years) who underwent AF catheter ablation. We measured the LAWT, LA endocardial curvature, and SD-curvature (surface bumpiness) from preprocedural computed tomography images...
2017: PloS One
https://www.readbyqxmd.com/read/28800192/efficacy-and-safety-of-driver-guided-catheter-ablation-for-atrial-fibrillation-a-systematic-review-and-meta-analysis
#9
F Daniel Ramirez, David H Birnie, Girish M Nair, Agnieszka Szczotka, Calum J Redpath, Mouhannad M Sadek, Pablo B Nery
INTRODUCTION: Targeting localized drivers (electrical rotors or focal impulses) during catheter ablation for atrial fibrillation (AF) has been proposed as a strategy to improve procedural success. However, the strength and quality of the evidence to support this approach is unclear. METHODS AND RESULTS: Clinical studies reporting efficacy or safety outcomes of driver-guided ablation for AF were identified in Medline, Embase, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Pubmed, and conference abstracts from major scientific meetings...
August 11, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28800169/global-multielectrode-contact-mapping-plus-ablation-with-a-single-catheter-preclinical-and-preliminary-experience-in-humans-with-atrial-fibrillation
#10
Hans Kottkamp, Fabian Moser, Andreas Rieger, Doreen Schreiber, Christian Pönisch, Monica Trofin
INTRODUCTION: One question for the technological advancement of catheter ablation of atrial fibrillation (AF) is whether a creative new concept can combine and even improve the diagnostic mapping options of single-tip and basket catheters with the simplicity of the use of balloon catheters for ablation. Herein, we describe the first in-human experience with a single catheter offering such a complete solution. METHODS AND RESULTS: A new catheter (Globe(®) ) with a distal multielectrode array consisting of 16 ribs with 122 gold-plated electrodes was used...
November 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28795289/beyond-pulmonary-vein-isolation-the-role-of-additional-sites-in-catheter-ablation-of-atrial-fibrillation
#11
REVIEW
Li-Wei Lo, Yenn-Jiang Lin, Shih-Lin Chang, Yu-Feng Hu, Fa-Po Chung, Shih-Ann Chen
PURPOSE OF REVIEW: Pulmonary vein (PV) isolation is the cornerstone of atrial fibrillation (AF) ablation. However, the long-term procedural outcome remains suboptimal and there is a frequent need for repeat ablation procedure, especially in patients with non-paroxysmal AF. The review article summarizes the rationales, recent evidences, and strategies of ablation of extra-PV sites and its clinical outcomes. RECENT FINDINGS: It is a consensus that durable PV isolations are a definite therapy in patients with paroxysmal AF...
August 9, 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28790104/first-in-man-analysis-of-the-relationship-between-electrical-rotors-from-noninvasive-panoramic-mapping-and-atrial-fibrosis-from-magnetic-resonance-imaging-in-patients-with-persistent-atrial-fibrillation
#12
Christian Sohns, Christine Lemes, Andreas Metzner, Thomas Fink, Mikhail Chmelevsky, Tilman Maurer, Margarita Budanova, Vladislav Solntsev, Walther H W Schulze, Wieland Staab, Shibu Mathew, Christian Heeger, Bruno Reißmann, Eugene Kholmovski, Dietmar Kivelitz, Feifan Ouyang, Karl-Heinz Kuck
BACKGROUND: Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging can be used to evaluate characteristics of atrial fibrosis. The novel noninvasive epicardial and endocardial electrophysiology system (NEEES) allows for the identification of sources with rotor activity. This study describes a new technique to examine the relationship between rotors and LGE signal intensity in patients with persistent atrial fibrillation (PERS) scheduled for ablation. METHODS AND RESULTS: Ten consecutive patients underwent pulmonary vein isolation for persistent atrial fibrillation...
August 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/28733070/spatial-relationship-of-sites-for-atrial-fibrillation-drivers-and-atrial-tachycardia-in-patients-with-both-arrhythmias
#13
Tina Baykaner, Junaid A B Zaman, Albert J Rogers, Rachita Navara, Mahmood AlHusseini, Ryan T Borne, Shirley Park, Paul J Wang, David E Krummen, William H Sauer, Sanjiv M Narayan
INTRODUCTION: Atrial fibrillation (AF) often converts to and from atrial tachycardia (AT), but it is undefined if these rhythms are mechanistically related in such patients. We tested the hypothesis that critical sites for AT may be related to regional AF sources in patients with both rhythms, by mapping their locations and response to ablation on transitions to and from AF. METHODS: From 219 patients undergoing spatial mapping of AF prior to ablation at 3 centers, we enrolled 26 patients in whom AF converted to AT by ablation (n=19) or spontaneously (n=7; left atrial size 42±6cm, 38% persistent AF)...
December 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28697936/radiofrequency-catheter-ablation-for-atrial-fibrillation-approaches-and-outcomes
#14
REVIEW
Manish Kalla, Prashanthan Sanders, Jonathan M Kalman, Geoffrey Lee
Catheter ablation is now at the forefront of the management of symptomatic atrial fibrillation (AF). Its role in paroxysmal AF is well defined with considerable data supporting its role. Catheter ablation in persistent AF has been less effective and the subject of considerable debate. Mechanistic studies have demonstrated the critical role of pulmonary vein physiology in paroxysmal AF, whereas the mechanisms that sustain persistent AF are not well understood. Additional substrate ablation in persistent AF has not improved long-term outcomes and the use of novel mapping technologies to assess rotor activity remains controversial...
June 13, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28678805/ablation-as-targeted-perturbation-to-rewire-communication-network-of-persistent-atrial-fibrillation
#15
Susumu Tao, Samuel F Way, Joshua Garland, Jonathan Chrispin, Luisa A Ciuffo, Muhammad A Balouch, Saman Nazarian, David D Spragg, Joseph E Marine, Ronald D Berger, Hugh Calkins, Hiroshi Ashikaga
Persistent atrial fibrillation (AF) can be viewed as disintegrated patterns of information transmission by action potential across the communication network consisting of nodes linked by functional connectivity. To test the hypothesis that ablation of persistent AF is associated with improvement in both local and global connectivity within the communication networks, we analyzed multi-electrode basket catheter electrograms of 22 consecutive patients (63.5 ± 9.7 years, 78% male) during persistent AF before and after the focal impulse and rotor modulation-guided ablation...
2017: PloS One
https://www.readbyqxmd.com/read/28596994/recurrent-post-ablation-paroxysmal-atrial-fibrillation-shares-substrates-with-persistent-atrial-fibrillation-an-11-center-study
#16
Junaid A B Zaman, Tina Baykaner, Paul Clopton, Vijay Swarup, Robert C Kowal, James P Daubert, John D Day, John Hummel, Amir A Schricker, David E Krummen, Moussa Mansour, Gery F Tomassoni, Kevin R Wheelan, Mohan Vishwanathan, Shirley Park, Paul J Wang, Sanjiv M Narayan, John M Miller
INTRODUCTION: The role of atrial fibrillation (AF) substrates is unclear in patients with paroxysmal AF (PAF) that recurs after pulmonary vein isolation (PVI). We hypothesized that patients with recurrent post-ablation (redo) PAF despite PVI have electrical substrates marked by rotors and focal sources, and structural substrates that resemble persistent AF more than patients with (de novo) PAF at first ablation. METHODS: In 175 patients at 11 centers, we compared AF substrates in both atria using 64 pole-basket catheters and phase mapping, and indices of anatomical remodeling between patients with de novo or redo PAF and first ablation for persistent AF...
April 2017: JACC. Clinical Electrophysiology
https://www.readbyqxmd.com/read/28523369/-new-strategies-and-technologies-for-ablation-of-atrial-fibrillation-where-do-we-go
#17
A Metzner, J Riedl, K-H Kuck
Catheter-based ablation is an established treatment option for patients with symptomatic atrial fibrillation (AF). Pulmonary vein isolation is the established cornerstone of all ablation strategies. However, the rate of electrical reconduction of previously isolated pulmonary veins is high and associated with recurrence of AF. Novel and innovative mapping and ablation systems are being developed or are under clinical evaluation aiming for higher durability of pulmonary vein isolation. Additional ablation strategies for patients with recurrence of AF despite persistent isolation of the pulmonary veins are under evaluation...
June 2017: Herz
https://www.readbyqxmd.com/read/28500479/-catheter-ablation-of-persistent-atrial-fibrillation-where-do-we-go
#18
C Lemeš, K-H Kuck, S Mathew
Despite the very promising initial results of clinical studies, catheter ablation of persistent atrial fibrillation (AF) remains a challenge in modern electrophysiology. On the basis of the hypothesized pathophysiological mechanisms, a variety of ablation strategies have been developed over the course of time. The current ablation strategies range from pulmonary vein isolation (PVI) alone as first-line therapy, through ablation of multiple linear lesions, ablation of complex fractionated atrial electrograms (CFAE), rotor ablation, isolation of fibrotic and scar tissue up to isolation of the left atrial appendage (LAA); however, it is unclear even to the present day whether these complex and time-consuming strategies actually improve the success rate of ablation therapy...
June 2017: Herz
https://www.readbyqxmd.com/read/28471019/type-and-rate-of-atrial-fibrillation-termination-due-to-rotational-activity-ablation-combined-with-pulmonary-vein-isolation
#19
Zsuzsanna Kis, Dominic A Theuns, Rohit Bhagwandien, Sip Wijchers, Sing-Chien Yap, Tamas Szili-Torok
BACKGROUND: There remains controversy about the optimal ablation technique and termination rate of atrial fibrillation (AF) during catheter ablation in patients with persistent AF. The aim of this study was to determine the rate and timing of AF termination during combined pulmonary vein isolation (PVI) and focal impulse and rotor modulation (FIRM)-guided ablation of rotational activity (RoAc). METHODS: This single-center, prospective cohort study enrolled 38 consecutive patients (63% male, mean age 63 ± 11 years) with persistent AF (mean left atrial size: 46 ± 7 mm), who underwent FIRM mapping and ablation of the identified RoAcs followed by PVI...
August 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28438722/propagation-of-meandering-rotors-surrounded-by-areas-of-high-dominant-frequency-in-persistent-atrial-fibrillation
#20
João Salinet, Fernando S Schlindwein, Peter Stafford, Tiago P Almeida, Xin Li, Frederique J Vanheusden, María S Guillem, G André Ng
BACKGROUND: Identification of arrhythmogenic regions remains a challenge in persistent atrial fibrillation (persAF). Frequency and phase analysis allows identification of potential ablation targets. OBJECTIVE: This study aimed to investigate the spatiotemporal association between dominant frequency (DF) and reentrant phase activation areas. METHODS: A total of 8 persAF patients undergoing first-time catheter ablation procedure were enrolled...
April 22, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
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