Simultaneous biatrial and noncontact mapping in 50 patients with refractory AF revealed that 44% had ≥2 disparate regional origins of atrial premature beats.
Observational (n=50)
Does simultaneous biatrial and three-dimensional noncontact mapping provide novel information on triggers, initiation, and evolution of spontaneous AF in patients with refractory AF?
Simultaneous biatrial and noncontact mapping reveals a biatrial spectrum of spontaneous triggers and organized monomorphic tachycardias in human AF, with more extensive distribution in patients with structural heart disease or persistent AF.
INTRODUCTION: While atrial fibrillation (AF) initiation in the pulmonary veins has been well-studied, simultaneous biatrial and three-dimensional noncontact mapping (NCM) has not been performed. We hypothesized that these two techniques would provide novel information on triggers, initiation, and evolution of spontaneous AF and permit study of different AF populations. METHODS AND RESULTS: The origin of atrial premature beats (APBs), onset of spontaneous AF and its evolution were analyzed in 50 patients with AF in the presence or absence of structural heart disease (SHD) and in different AF presentations (group A: Persistent, group B: Paroxysmal). In 45 patients, spontaneous APBs in the right atrium (RA; n = 60) and left atrium (LA; n = 25) with similar regional distributions regardless of heart disease status were demonstrated. In total, 22 patients (44%) had > or =2 disparate regional origins. Biatrial regional foci were seen with equal frequency in patients with SHD (31%), without SHD (40%), in group A (32%), and in group B (36%). Biatrial mapping and NCM showed organized monomorphic atrial tachyarrhythmias arising in the RA (17), septum (17), or LA (21) and were classified as atrial flutter (RA = 34, LA = 8), macro-reentrant atrial tachycardia (RA = 1, LA = 3) or focal atrial tachycardia (RA = 2, LA = 7). Their regional distribution was more extensive in patients with SHD and persistent AF compared with patients without SHD or paroxysmal AF. Simultaneous biatrial tachycardias were observed only in group A patients and those with SHD. CONCLUSIONS: Simultaneous biatrial and NCM permits successful AF mapping in different AF populations and demonstrates a biatrial spectrum of spontaneous triggers and tachycardias. Organized monomorphic tachycardias with multiple unilateral or biatrial locations are commonly observed in human AF. Patients with heart disease or persistent AF have a more extensive distribution as well as simultaneous coexistence of multiple tachycardias during AF.
Saksena et al. (Tue,) conducted a observational in Refractory Atrial Fibrillation (n=50). Simultaneous biatrial and three-dimensional noncontact mapping was evaluated on Origin of atrial premature beats, onset of spontaneous AF and its evolution. Simultaneous biatrial and noncontact mapping in 50 patients with refractory AF revealed that 44% had ≥2 disparate regional origins of atrial premature beats.
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