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Driver characteristics associated with structurally and electrically remodeled atria in persistent atrial fibrillation

Dhillon, GS; Honarbakhsh, S; Graham, A; Ahluwalia, N; Abbas, H; Welch, S; Daw, H; ... Hunter, RJ; + view all (2022) Driver characteristics associated with structurally and electrically remodeled atria in persistent atrial fibrillation. Heart Rhythm O2 10.1016/j.hroo.2022.09.016. (In press). Green open access

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Abstract

BACKGROUND: Recent studies suggest persistent atrial fibrillation (AF) is maintained by localized focal or rotational electrical activations termed drivers. OBJECTIVE: The purpose of this study was to evaluate how left atrial (LA) dilation and time in AF impact persistent AF mechanisms. METHODS: Patients with persistent AF <2 years underwent electrocardiographic image mapping. Potential drivers (PDs) were defined as rotational wavefront activity ≥1.5 revolutions or focal activations. Distribution of PDs was recorded using an 18-segment model. RESULTS: One hundred patients were enrolled (age 61.3 ± 12.1 years). Of these patients, 47 were hypertensive, 14 had diabetes mellitus, and 10 had ischemic heart disease. AF duration was 8 [5–15] months. Median LA diameter was 39 [33–43] mm. Although LA dimensions did not correlate with overall PD burden or distribution, there was a modest correlation between increasing LA area (r = 0.235; P = .024) and LA volume (r = 0.216; P = .039) with proportion of PDs that were rotational. Although time in AF did not correlate with overall PD burden or distribution, there was a correlation between time in AF and the number of focal PDs (r = 0.203; P = .044). Female gender, increasing age, and hypertension also were associated with an increase in focal PDs. CONCLUSION: This is the first study to demonstrate different AF mechanisms in patient subgroups. Greater understanding of patient-specific AF mechanisms may facilitate a tailored approach to AF mapping and ablation.

Type: Article
Title: Driver characteristics associated with structurally and electrically remodeled atria in persistent atrial fibrillation
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.hroo.2022.09.016
Publisher version: https://doi.org/10.1016/j.hroo.2022.09.016
Language: English
Additional information: © 2022 Heart Rhythm Society. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Keywords: Arrhythmia; Atrial fibrillation; CardioInsight; Electrocardiographic imaging; Mapping; Remodeling
UCL classification: UCL
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 Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10161309
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