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Characterization of drivers maintaining atrial fibrillation: Correlation with markers of rapidity and organization on spectral analysis

Honarbakhsh, S; Schilling, RJ; Providencia, R; Keating, E; Chow, A; Sporton, S; Lowe, M; ... Hunter, RJ; + view all (2018) Characterization of drivers maintaining atrial fibrillation: Correlation with markers of rapidity and organization on spectral analysis. Heart Rhythm , 15 (9) pp. 1296-1303. 10.1016/j.hrthm.2018.04.020.

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Abstract

BACKGROUND: Better characterization of drivers in atrial fibrillation (AF) may facilitate their identification. OBJECTIVE: The purpose of this study was to demonstrate that certain driver characteristics are associated with greater mechanistic importance in maintaining AF. METHODS: Persistent AF was mapped in patients using the CARTOFINDER system with a 64-pole basket catheter to identify and ablate drivers with rotational or focal activity after pulmonary vein isolation. An ablation response was defined as cycle length (CL) slowing ≥30 ms or AF termination. Driver sites with an ablation response were correlated to sites of fastest CL, highest dominant frequency (DF), and greatest organization (lowest cycle length variability [CLV] and highest regularity index [RI]). Parameters predicting AF termination with driver ablation were evaluated. RESULTS: All 29 patients had ≥1 driver identified. Forty-four potential drivers were identified. The predefined ablation response occurred with 39 drivers (89%): 23 rotational and 16 focal. During a 30-second recording, each driver occurred 8.7 ± 5.4 times and completed 3.1 ± 0.9 consecutive repetitions per occurrence. Driver sites correlated best with markers of organization, corresponding to the site of lowest CLV (29/39 [74%]) and highest RI (26/39 [67%]). Correlation with sites of fastest CL and highest DF was poor (17/39 and 15/39, respectively) and depended on driver temporal stability. Greater temporal stability (3.4 ± 0.9 vs 2.7 ± 0.6; P = .001) and driver correlation with sites of lowest CLV and highest RI (both P <.001) predicted AF termination with ablation. CONCLUSION: Intermittent focal or rotational drivers were identified in all patients. Drivers consistently correlated to organization markers. Greater temporal stability and organization predicted AF termination with driver ablation.

Type: Article
Title: Characterization of drivers maintaining atrial fibrillation: Correlation with markers of rapidity and organization on spectral analysis
DOI: 10.1016/j.hrthm.2018.04.020
Publisher version: https://doi.org/10.1016/j.hrthm.2018.04.020
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Atrial fibrillation, Cycle length, Dominant frequency, Pulmonary vein isolation, Rotors
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Health Informatics
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Health Informatics > Clinical Epidemiology
URI: http://discovery.ucl.ac.uk/id/eprint/10067643
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