Slow Conduction Corridors and Pivot Sites Characterize the Electrical Remodeling in Atrial Fibrillation
Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved..
OBJECTIVES: This study aimed to evaluate the progression of electrophysiological phenomena in a cohort of patients with paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PsAF).
BACKGROUND: Electrical remodeling has been conjectured to determine atrial fibrillation (AF) progression.
METHODS: High-density electroanatomic maps during sinus rhythm of 20 patients with AF (10 PAF, 10 PsAF) were compared with 5 healthy control subjects (subjects undergoing ablation of a left-sided accessory pathway). A computational postprocessing of electroanatomic maps was performed to identify specific electrophysiological phenomena: slow conductions corridors, defined as discrete areas of conduction velocity <50 cm/s, and pivot points, defined as sites showing high wave-front curvature documented by a curl module >2.5 1/s.
RESULTS: A progressive decrease of mean conduction velocity was recorded across the groups (111.6 ± 55.5 cm/s control subjects, 97.1 ± 56.3 cm/s PAF, and 84.7 ± 55.7 cm/s PsAF). The number and density of slow conduction corridors increase in parallel with the progression of AF (8.6 ± 2.2 control subjects, 13.3 ± 3.2 PAF, and 20.5 ± 4.5 PsAF). In PsAF the atrial substrate is characterized by a higher curvature of wave-front propagation (0.86 ± 0.71 1/s PsAF vs 0.74 ± 0.63 1/s PAF; P = 0.003) and higher number of pivot points (25.1 ± 13.8 PsAF vs 9.5 ± 6.7 PAF; P < 0.0001). Slow conductions: corridors were mostly associated with pivot sites tending to cluster around pulmonary veins antra.
CONCLUSIONS: The electrical remodeling hinges mainly on corridors of slow conduction and higher curvature of wave-front propagation. Pivot points associated to SC corridors may be the major determinants for functional localized re-entrant circuits creating the substrate for maintenance of AF.
| Errataetall: |
CommentIn: JACC Clin Electrophysiol. 2022 May;8(5):578-581. - PMID 35589169 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
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| Enthalten in: |
JACC. Clinical electrophysiology - 8(2022), 5 vom: 24. Mai, Seite 561-577 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Frontera, Antonio [VerfasserIn] |
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| Links: |
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| Themen: |
Atrial fibrillation |
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| Anmerkungen: |
Date Completed 23.05.2022 Date Revised 29.05.2022 published: Print-Electronic CommentIn: JACC Clin Electrophysiol. 2022 May;8(5):578-581. - PMID 35589169 Citation Status MEDLINE |
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| doi: |
10.1016/j.jacep.2022.01.019 |
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| Förderinstitution / Projekttitel: |
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| 500 | |a CommentIn: JACC Clin Electrophysiol. 2022 May;8(5):578-581. - PMID 35589169 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVES: This study aimed to evaluate the progression of electrophysiological phenomena in a cohort of patients with paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PsAF) | ||
| 520 | |a BACKGROUND: Electrical remodeling has been conjectured to determine atrial fibrillation (AF) progression | ||
| 520 | |a METHODS: High-density electroanatomic maps during sinus rhythm of 20 patients with AF (10 PAF, 10 PsAF) were compared with 5 healthy control subjects (subjects undergoing ablation of a left-sided accessory pathway). A computational postprocessing of electroanatomic maps was performed to identify specific electrophysiological phenomena: slow conductions corridors, defined as discrete areas of conduction velocity <50 cm/s, and pivot points, defined as sites showing high wave-front curvature documented by a curl module >2.5 1/s | ||
| 520 | |a RESULTS: A progressive decrease of mean conduction velocity was recorded across the groups (111.6 ± 55.5 cm/s control subjects, 97.1 ± 56.3 cm/s PAF, and 84.7 ± 55.7 cm/s PsAF). The number and density of slow conduction corridors increase in parallel with the progression of AF (8.6 ± 2.2 control subjects, 13.3 ± 3.2 PAF, and 20.5 ± 4.5 PsAF). In PsAF the atrial substrate is characterized by a higher curvature of wave-front propagation (0.86 ± 0.71 1/s PsAF vs 0.74 ± 0.63 1/s PAF; P = 0.003) and higher number of pivot points (25.1 ± 13.8 PsAF vs 9.5 ± 6.7 PAF; P < 0.0001). Slow conductions: corridors were mostly associated with pivot sites tending to cluster around pulmonary veins antra | ||
| 520 | |a CONCLUSIONS: The electrical remodeling hinges mainly on corridors of slow conduction and higher curvature of wave-front propagation. Pivot points associated to SC corridors may be the major determinants for functional localized re-entrant circuits creating the substrate for maintenance of AF | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a pivot points | |
| 650 | 4 | |a slow conduction | |
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| 700 | 1 | |a Peirone, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Fioravanti, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Enache, Bogdan |e verfasserin |4 aut | |
| 700 | 1 | |a Cuellar Silva, Jose |e verfasserin |4 aut | |
| 700 | 1 | |a Vlachos, Konstantinos |e verfasserin |4 aut | |
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