Abstract 16807: Role of Rotor Activation Within the Pulmonary Vein as the Driving Sources for Atrial Fibrillation: Three-dimensional Analysis using a Non-contact Mapping System

Background: It has been suggested rotor which is located within the pulmonary vein (PV) acted as the driving sources of atrial fibrillation (AF). However, it has never been confirmed whether or not the rotor exists within PV in human. Objectives: We analyzed the activation sequence within the PV during AF and examined how the PV acted as the driving sources of AF. Methods: Selective endocardial mapping of left superior PV (LSPV) was performed during AF in 11 paroxysmal AF patients using a non-contact mapping system (EnSite 3000). Presence of rotor activation was defined when the circular activation around the functional block line once completed its whole reentrant activation. We analyzed the relation between the pivoting activation and the rotor activation. To define the preferable site of rotor and pivoting activation, we also analyzed the relation between the location of rotor and pivoting activation and region of the complex fractionated electrogram (CFE) recording site. Results: Rotor activation was observed with a mean number of 4.6±3.6 times/sec. CFE was observed at the roof (n=5), ridge (n=11) and carina (n=7) of the proximal half of LSPV with a mean area of 9.1±3.4 cm2. The number of rotor activation observed at the CFE area was significantly higher than that at the non-CFE area (4.1±3.9 vs. 0.7±1.2 times/sec, p=0.025). Total frequency of pivoting activation was 37.0±14.7 times/sec. Pivoting activation involved in the rotor activation was significantly lower than that not involved in the rotor activation (8.8±8.1 vs. 27.7±15.8 times/sec, p=0.0116). Regarding the CFE area, pivoting activation involved in the rotor activation was also significantly lower than that not involved in the rotor activation (8.4±8.2 vs. 24.1±12.0 times/sec, p=0.0105). However, there was no difference between the frequencies of pivoting activation with and without rotor activation in the non-CFE area (1.0±2.0 vs. 3.6±6.1 times/sec, p=NS). Conclusions: Rotor activation was observed at the proximal portion of the LSPV coincided with the location of CFE area. However, most of pivoting activation was not involved in the rotor activation. These suggest that AF was driven by the other meandering propagation associated with frequent non-stable pivoting activation over the CFE area.

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Abstract 16789: Activation Sequence within the Pulmonary Vein as the Driving Sources of Atrial Fibrillation: Three-dimensional Analysis Using a Non-contact Mapping System

Circulation ◽

10.1161/circ.132.suppl_3.16789 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Hiroshige Yamabe ◽

Hisanori Kanazawa ◽

Tadashi Hoshiyama ◽

Miwa Ito ◽

Shozo Kaneko ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Three Dimensional ◽

Radiofrequency Energy ◽

Contact Mapping ◽

Energy Applications ◽

Frequent Episodes ◽

Mapping System ◽

Wave Break ◽

Activation Sequence

Background: The mechanisms how the activation within the pulmonary vein (PV) drives the atrial fibrillation (AF) has not been elucidated. Objectives: To define the AF maintenance mechanism by PV, we analyzed the activation sequence within the PV during AF. Methods: Selective endocardial mapping of the left superior PV (LSPV) was performed during AF in 11 patients with paroxysmal AF using a three-dimensional non-contact mapping system (EnSite 3000). In addition, we analyzed how the circumferential radiofrequency energy applications around the LSPV alter the activation of the LSPV and terminate AF. Results: Complex fractionated electrograms (CFE) were observed at the second half of the proximal LSPV at the roof (n=5), ridge (n=11) and carina (n=7). Mean CFE area was 9.1±3.4 cm2, which occupied the 19.8% of the LSPV area. Frequent episodes of pivoting activation associated with wave break and fusion was observed at this CFE area. The frequency of pivoting activation around the functional conduction block, wave break and fusion at the CFE region were significantly higher than those at the non-CFE region (32.5±12.2 vs. 4.6±5.8 times/sec; p<0.0001, 9.2±5.1 vs. 1.4±3.1 times/sec; p=0.0007, and 12.9±4.8 vs. 6.4±4.4 times/sec, p=0.0044). After isolation of ipsilateral right PV, subsequent circumferential radiofrequency energy applications around the left PV terminate the AF with a mean number of 13.5±7.8 applications, including LSPV roof (n=3.0±2.2) and LSPV ridge (n=5.6±1.9) lesions. AF was terminated before left PV isolation in all patients. The frequency of pivoting activation, wave break and fusion at all PV area just before the AF termination were significantly lower than those before ablation (8.1±11.7 vs. 37.0±14.7 times/sec; p<0.0001, 2.3±5.8 vs. 10.6±6.6 times/sec; p=0.005, 6.9±6.8 vs. 19.3±7.1 times/sec, p=0.0004), suggesting that linear lesion eliminate the random wave propagation over the CFE area. Conclusions: AF was driven by the high frequent episodes of pivoting activation associated with wave break and wave fusion observed over the CFE area at the proximal PV. Linear lesions along the left PV including CFE area of the LSPV eliminate the meandering activation over the CFE area, resulting in the termination of AF.

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Empirical Pulmonary Vein Isolation in Patients with Chronic Atrial Fibrillation Using a Three-Dimensional Nonfluoroscopic Mapping System: Long-Term Follow-Up

Pacing and Clinical Electrophysiology ◽

10.1046/j.1460-9592.2001.01774.x ◽

2001 ◽

Vol 24 (12) ◽

pp. 1774-1779 ◽

Cited By ~ 124

Author(s):

LOGAN KANAGARATNAM ◽

GERY TOMASSONI ◽

ROBERT SCHWEIKERT ◽

STEPHEN PAVIA ◽

DIANNA BASH ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Three Dimensional ◽

Chronic Atrial Fibrillation ◽

Mapping System ◽

Long Term Follow Up

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Catheter Ablation of Atrial Fibrillation: Three-dimensional Transesophageal Echocardiography Provides an Excellent Overview over the Pulmonary Vein Anatomy Facilitating Radiofrequency and Cryoablation Procedures

Cardiology and Angiology An International Journal ◽

10.9734/ca/2017/34273 ◽

2017 ◽

Vol 6 (2) ◽

pp. 1-18 ◽

Cited By ~ 1

Author(s):

Klaus Kettering ◽

Felix Gramley ◽

Stephan Bardeleben

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Transesophageal Echocardiography ◽

Pulmonary Vein ◽

Three Dimensional ◽

Pulmonary Vein Anatomy

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Three-Dimensional Impedance Mapping as an Aid to Circumferential Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation

Revista Española de Cardiología (English Edition) ◽

10.1016/s1885-5857(09)71563-4 ◽

2009 ◽

Vol 62 (3) ◽

pp. 315-319

Author(s):

Alonso Pedrote ◽

Eduardo Arana-Rueda ◽

Lorena García-Riesco ◽

Adriano Jiménez-Velasco ◽

Juan Sánchez-Brotons ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Three Dimensional ◽

Circumferential Pulmonary Vein Isolation

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Analysis of the driving mechanism in paroxysmal atrial fibrillation: comparison of the activation sequence between the left atrial body and pulmonary vein

Journal of Cardiology ◽

10.1016/j.jjcc.2020.01.004 ◽

2020 ◽

Vol 75 (6) ◽

pp. 673-681

Author(s):

Takuya Kiyama ◽

Hisanori Kanazawa ◽

Hiroshige Yamabe ◽

Miwa Ito ◽

Shozo Kaneko ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Driving Mechanism ◽

Activation Sequence

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P1724Left atrial volume computed by three-dimensional rotational angiography best predicts atrial fibrillation recurrence after pulmonary vein isolation

EP Europace ◽

10.1093/ehjci/eux161.034 ◽

2017 ◽

Vol 19 (suppl_3) ◽

pp. iii373-iii373

Author(s):

T. Strisciuglio ◽

SC. Chatzikyriakou ◽

GDG Di Gioia ◽

ES. Silva ◽

EB. Barbato ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Three Dimensional ◽

Atrial Fibrillation Recurrence ◽

Rotational Angiography ◽

Atrial Volume

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Can an increase in the pulmonary vein volume measured by three dimensional computed tomography predict the presence of atrial fibrillation?

Journal of Arrhythmia ◽

10.1002/joa3.12158 ◽

2019 ◽

Vol 35 (2) ◽

pp. 230-237

Author(s):

Masaaki Kurata ◽

Taku Asano ◽

Hiroyoshi Mori ◽

Hiroshi Mase ◽

Sakura Nagumo ◽

...

Keyword(s):

Computed Tomography ◽

Atrial Fibrillation ◽

Pulmonary Vein ◽

Three Dimensional

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Fluoroscopy-Free Pulmonary Vein Isolation in Patients with Atrial Fibrillation and a Patent Foramen Ovale Using Solely an Electroanatomic Mapping System

PLoS ONE ◽

10.1371/journal.pone.0148059 ◽

2016 ◽

Vol 11 (1) ◽

pp. e0148059 ◽

Cited By ~ 10

Author(s):

Michael Kühne ◽

Sven Knecht ◽

Aline Mühl ◽

Tobias Reichlin ◽

Nikola Pavlović ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Patent Foramen Ovale ◽

Electroanatomic Mapping ◽

Foramen Ovale ◽

Electroanatomic Mapping System ◽

Mapping System

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The Role of Adenosine in Pulmonary Vein Isolation: A Critical Review

Cardiology Research and Practice ◽

10.1155/2016/8632509 ◽

2016 ◽

Vol 2016 ◽

pp. 1-13 ◽

Cited By ~ 12

Author(s):

Paolo D. Dallaglio ◽

Timothy R. Betts ◽

Matthew Ginks ◽

Yaver Bashir ◽

Ignasi Anguera ◽

...

Keyword(s):

Atrial Fibrillation ◽

At Risk ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Waiting Time ◽

Critical Review ◽

Recurrence Rates ◽

The Impact ◽

Af Recurrence

The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI), which can be achieved in more than 95% of patients at the end of the procedure. However, AF recurrence rates remain high and are related to recovery of PV conduction. Adenosine testing is used to unmask dormant pulmonary vein conduction (DC). The aim of this study is to review the available literature addressing the role of adenosine testing and determine the impact of ablation at sites of PV reconnection on freedom from AF. Adenosine infusion, by restoring the excitability threshold, unmasks reversible injury that could lead to recovery of PV conduction. The studies included in this review suggest that adenosine is useful to unmask nontransmural lesions at risk of reconnection and that further ablation at sites of DC is associated with improvement in freedom from AF. Nevertheless it has been demonstrated that adenosine is not able to predict all veins at risk of later reconnection, which means that veins without DC are not necessarily at low risk. The role of the waiting period in the setting of adenosine testing has also been analyzed, suggesting that in the acute phase adenosine use should be accompanied by enough waiting time.

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