• Heart Rhythm · Dec 2013

    Localized rotational activation in the left atrium during human atrial fibrillation: relationship to complex fractionated atrial electrograms and low-voltage zones.

    • B Ghoraani, R Dalvi, S Gizurarson, M Das, A Ha, A Suszko, S Krishnan, and V S Chauhan.
    • Department of Engineering, Rochester Institute of Technology, Rochester, New York.
    • Heart Rhythm. 2013 Dec 1; 10 (12): 1830-8.

    BackgroundIn humans, the existence of rotors or reentrant sources maintaining atrial fibrillation (AF) and the underlying electroanatomic substrate has not been well defined.ObjectiveOur aim was to determine the prevalence of localized rotational activation (RotA) in the left atrium (LA) during human AF and whether complex fractionated atrial electrograms (CFAEs) or low-voltage areas colocalize with RotA sites.MethodsWe prospectively studied 32 patients (mean age 57 ± 8 years; 88% with persistent AF) undergoing AF catheter ablation. Bipolar electrograms were recorded for 2.5 seconds during AF using a roving 20-pole circular catheter in the LA. RotA was defined as sequential temporal activation of bipoles around the circular catheter. Bipolar electrogram fractionation index and bipolar voltage were used to define CFAEs and low-voltage areas, respectively.ResultsIn 21 (66%) patients, 47 RotA sites were identified. Few (9%) lasted 2.5 seconds (cycle length 183 ± 6 ms), while the majority (91%) were nonsustained (duration 610 ± 288 ms; cycle length 149 ± 11 ms). RotA was most common in the pulmonary vein antrum (71%) and posterior LA (25%). CFAEs were recorded from 18% ± 12% of LA area, and most (92% ± 7%) were not associated with RotA sites. However, 85% of RotA sites contained CFAEs. Very low voltage (<0.1 mV) areas comprised 12% ± 10% of LA area and were present in 23% of RotA sites.ConclusionsIn patients with predominantly persistent AF, localized RotA is commonly present but tends to be transient (<1 second). Although most CFAEs do not colocalize with RotA sites, the high prevalence of CFAEs and very low voltages within RotA sites may indicate slow conduction in diseased myocardium necessary for their maintenance.© 2013 Heart Rhythm Society Published by Heart Rhythm Society All rights reserved.

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