Spatial and temporal variability of rotational, focal, and irregular activity: Practical implications for mapping of atrial fibrillation
Spatial and temporal variability of rotational, focal, and irregular activity: Practical implications for mapping of atrial fibrillation
Background: Charge density mapping of atrial fibrillation (AF) reveals dynamic localized rotational activation (LRA), irregular activation (LIA) and focal firing (FF). Their spatial stability, conduction characteristics and the optimal duration of mapping required to reveal these phenomena and has not been explored. Methods: Bi-atrial mapping of AF propagation was undertaken using AcQMap (Acutus Medical) and variability of activation patterns quantified up to a duration of 30 s. The frequency of each pattern was quantified at each unique point of the chamber over two separate 30-s recordings before ablation and R2 calculated to quantify spatial stability. Regions with the highest frequency were identified at increasing time durations and compared to the result over 30 s using Cohen's kappa. Properties of regions with the most stable patterns were assessed during sinus rhythm and extrastimulus pacing. Results: In 21 patients, 62 paired LA and RA maps were obtained. LIA was highly spatially stable with R2 between maps of 0.83 (0.71–0.88) compared to 0.39 (0.24–0.57), and 0.64 (0.54–0.73) for LRA and FF, respectively. LIA was most temporally stable with a kappa of >0.8 reached by 12 s. LRA showed greatest variability with kappa >0.8 only after 22 s. Regions of LIA were of normal voltage amplitude (1.09 mv) but showed increased conduction heterogeneity during extrastimulus pacing (p =.0480). Conclusion: Irregular activation patterns characterized by changing wavefront direction are temporally and spatially stable in contrast with LRA that is transient with least spatial stability. Focal activation appears of intermediate stability. Regions of LIA show increased heterogeneity following extrastimulus pacing and may represent fixed anatomical substrate.
Atrial Fibrillation/diagnosis, Catheter Ablation, Heart Atria/diagnostic imaging, Heart Conduction System, Heart Rate, Humans
2393-2403
Pope, Michael T.B.
4e7343b7-a8c4-4ce4-a813-ff0d894b0f92
Kuklik, Pawel
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Briosa e Gala, Andre
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Leo, Milena
a9342a4e-2bd1-4c2a-bc1b-46a8ffa29842
Mahmoudi, Michael
f6a55246-399e-4f81-944e-a4b169786e8a
Paisey, John
4d958db6-f32d-4ce7-bef5-003a4a358312
Betts, Timothy R.
a9d90073-a54a-478c-81f0-39ecc5234047
September 2021
Pope, Michael T.B.
4e7343b7-a8c4-4ce4-a813-ff0d894b0f92
Kuklik, Pawel
c9f1a20a-117f-47f5-b950-ddde0370d927
Briosa e Gala, Andre
409c30a8-0696-4426-9f9b-2539af465dbd
Leo, Milena
a9342a4e-2bd1-4c2a-bc1b-46a8ffa29842
Mahmoudi, Michael
f6a55246-399e-4f81-944e-a4b169786e8a
Paisey, John
4d958db6-f32d-4ce7-bef5-003a4a358312
Betts, Timothy R.
a9d90073-a54a-478c-81f0-39ecc5234047
Pope, Michael T.B., Kuklik, Pawel, Briosa e Gala, Andre, Leo, Milena, Mahmoudi, Michael, Paisey, John and Betts, Timothy R.
(2021)
Spatial and temporal variability of rotational, focal, and irregular activity: Practical implications for mapping of atrial fibrillation.
Journal of Cardiovascular Electrophysiology, 32 (9), .
(doi:10.1111/jce.15170).
Abstract
Background: Charge density mapping of atrial fibrillation (AF) reveals dynamic localized rotational activation (LRA), irregular activation (LIA) and focal firing (FF). Their spatial stability, conduction characteristics and the optimal duration of mapping required to reveal these phenomena and has not been explored. Methods: Bi-atrial mapping of AF propagation was undertaken using AcQMap (Acutus Medical) and variability of activation patterns quantified up to a duration of 30 s. The frequency of each pattern was quantified at each unique point of the chamber over two separate 30-s recordings before ablation and R2 calculated to quantify spatial stability. Regions with the highest frequency were identified at increasing time durations and compared to the result over 30 s using Cohen's kappa. Properties of regions with the most stable patterns were assessed during sinus rhythm and extrastimulus pacing. Results: In 21 patients, 62 paired LA and RA maps were obtained. LIA was highly spatially stable with R2 between maps of 0.83 (0.71–0.88) compared to 0.39 (0.24–0.57), and 0.64 (0.54–0.73) for LRA and FF, respectively. LIA was most temporally stable with a kappa of >0.8 reached by 12 s. LRA showed greatest variability with kappa >0.8 only after 22 s. Regions of LIA were of normal voltage amplitude (1.09 mv) but showed increased conduction heterogeneity during extrastimulus pacing (p =.0480). Conclusion: Irregular activation patterns characterized by changing wavefront direction are temporally and spatially stable in contrast with LRA that is transient with least spatial stability. Focal activation appears of intermediate stability. Regions of LIA show increased heterogeneity following extrastimulus pacing and may represent fixed anatomical substrate.
Text
Cardiovasc electrophysiol - 2021 - Pope - Spatial and temporal variability of rotational focal and irregular activity
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More information
Accepted/In Press date: 25 May 2021
e-pub ahead of print date: 14 July 2021
Published date: September 2021
Keywords:
Atrial Fibrillation/diagnosis, Catheter Ablation, Heart Atria/diagnostic imaging, Heart Conduction System, Heart Rate, Humans
Identifiers
Local EPrints ID: 453343
URI: http://eprints.soton.ac.uk/id/eprint/453343
ISSN: 1045-3873
PURE UUID: 2998015f-ebc0-4cc9-8500-2f97515390fb
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Date deposited: 13 Jan 2022 17:47
Last modified: 18 Mar 2024 03:34
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Contributors
Author:
Michael T.B. Pope
Author:
Pawel Kuklik
Author:
Andre Briosa e Gala
Author:
Milena Leo
Author:
John Paisey
Author:
Timothy R. Betts
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