Characterization and consistency of interactions of triggers and substrate at the onset of paroxysmal atrial fibrillation.
File(s)
Accepted version
Supporting information
Author(s)
Type
Journal Article
Abstract
Aims: Initiating mechanisms of atrial fibrillation (AF) remain poorly understood, involving complex interaction between triggers and the atrial substrate. This study sought to classify the transitional phenomena, hypothesizing that there is consistency within and between patients in trigger-substrate interaction during transition to AF. Methods and results: Non-contact left atrial (LA) mapping was performed in 17 patients undergoing ablation for paroxysmal AF. All had spontaneous ectopy. Left atrial activation from the first ectopic to established AF was examined offline to characterize the initiating and transitional sequence of activation. In 57 fully mapped spontaneous AF initiations in 8 patients, all involved interaction of pulmonary venous/LA triggers with a septopulmonary line of block (SP-LOB) also evident in sinus rhythm, by 4 different transitional mechanisms characterized by (i) continuous focal firing: AF resulted from fragmentation of each ectopic wavefront through gaps in the SP-LOB and persisted only while focal firing continued (n = 18/32%) (ii) transient focal firing, wavefront fragmentation at the SP-LOB produced wavelet re-entry that persisted after cessation of an initiating ectopic source (n = 12/21%), (iii) of two separate interacting ectopic foci (n = 15/26%), or from (iv) transiently stable macroreentry (n = 12/21%), around the SP-LOB extending to the LA roof, resulting in progressive wavefront fragmentation. It was found that 79 ± 22% of each of the initiations in individual patients showed the same triggering mechanism. Conclusion: Onset of paroxysmal AF can be described by discrete mechanistic categories, all involving interaction of ectopic activity with a common SP-LOB. Within/between-patient consistency of initiations suggests constancy of the interacting triggers and substrate, and supports the concept of mechanistically tailored treatment.
Date Issued
2017-01-25
Date Acceptance
2016-06-28
Citation
Europace, 2017, 19 (9), pp.1454-1462
ISSN
1099-5129
Publisher
Oxford University Press (OUP)
Start Page
1454
End Page
1462
Journal / Book Title
Europace
Volume
19
Issue
9
Copyright Statement
© 2017 The Author(s). For permissions please email: journals.permissions@oup.com. This is a pre-copy-editing, author-produced version of an article accepted for publication in Europace following peer review. The definitive publisher-authenticated version David G. Jones, Vias Markides, Anthony W. C. Chow, Richard J. Schilling, Prapa Kanagaratnam, Tom Wong, D. Wyn Davies, Nicholas S. Peters; Characterization and consistency of interactions of triggers and substrate at the onset of paroxysmal atrial fibrillation. Europace 2017 euw229. doi: 10.1093/europace/euw229 is available online at: https://dx.doi.org/10.1093/europace/euw229
Sponsor
British Heart Foundation
British Heart Foundation
British Heart Foundation
British Heart Foundation
British Heart Foundation
British Heart Foundation
British Heart Foundation
Rosetrees Trust
Identifier
PII: 2952941
Grant Number
RE/08/002/23906
RG/10/11/28457
FS/14/46/30907
PG/15/59/31621
PG/16/17/32069
PG/16/17/32069
RG/16/3/32175
A1173
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Atrial fibrillation
Mapping
Mechanisms
Substrate
Triggers
NONCONTACT MAPPING SYSTEM
POSTERIOR LEFT ATRIUM
SINUS RHYTHM
INITIATION
MECHANISM
HEART
VALIDATION
ABLATION
CATHETER
1103 Clinical Sciences
Cardiovascular System & Hematology
Publication Status
Published