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Driver domains in persistent atrial fibrillation.

Michel Haissaguerre1, Meleze Hocini1, Arnaud Denis1

  • 1From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 - ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 -LIRYC L'Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.).

Circulation
|July 17, 2014
PubMed
Summary

Identifying drivers in persistent atrial fibrillation (AF) using noninvasive signal processing revealed that early-stage AF is primarily driven by unstable reentrant circuits. Ablating these drivers offers an effective treatment strategy for atrial fibrillation.

Keywords:
atrial fibrillationmapping

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Imaging

Background:

  • Persistent atrial fibrillation (AF) management remains challenging.
  • Noninvasive signal processing offers a novel approach to understanding AF mechanisms.

Purpose of the Study:

  • To identify and characterize drivers of persistent AF using noninvasive signal processing.
  • To evaluate the efficacy of catheter ablation targeting identified drivers.

Main Methods:

  • Utilized noncontrast computed tomography for biatrial geometry and 252 body surface electrodes for electrogram acquisition.
  • Applied signal processing to identify focal and reentrant drivers and map their cumulative density.
  • Performed catheter ablation targeting driver regions with AF termination as the endpoint.

Main Results:

  • Identified 4720 drivers (80.5% reentries, 19.5% focal) in 103 patients, predominantly in the left atrium.
  • Driver ablation alone terminated 75% of persistent AF and 15% of long-lasting AF.
  • Targeted driver regions increased with AF duration, with declining termination rates after 6 months.

Conclusions:

  • Persistent AF in its early stages is primarily maintained by drivers in a few regions, mostly unstable reentries.
  • Catheter ablation targeting these drivers is effective and potentially more efficient than conventional methods.