Key Points
- To determine the 3D structural-functional mechanisms driving atrial fibrillation across the endocardial and epicardial layers in diseased human atria.
- Performed integrated 3D structural-functional imaging using simultaneous sub-epicardial and sub-endocardial optical mapping in explanted human right atria ex vivo.
- Assessed endocardial versus epicardial activation patterns during both paced rhythms and sustained atrial fibrillation.
- Complex atrial microstructure causes significant transmural activation differences between endocardial and epicardial surfaces during pacing.
- Sustained atrial fibrillation is maintained by micro-anatomic intramural re-entry anchored to fibrosis-insulated atrial muscle bundles.
Structured PICO
PPopulationExplanted diseased human right atria (ex vivo model)
IInterventionSimultaneous sub-epicardial and sub-endocardial optical mapping with pacing
OOutcomeDifferences between endocardial and epicardial activation during pacing and sustained atrial fibrillationsurrogate
Simultaneous optical mapping of explanted human hearts reveals that sustained atrial fibrillation is driven by intramural re-entry anchored to fibrosis-insulated atrial bundles.