Reduction of Conduction Velocity in Patients with Atrial Fibrillation

Figures

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  Figure 1. Method of epicardial mapping. (a) Mapping scheme on a schematic posterior view of the RA, BB, LA and PVA; (b) an example of a color-coded activation map with isochrones (black lines) drawn at 10 ms. The black arrow indicates the main wave direction. Examples of the corresponding CV map using discrete velocity vectors are shown next to the activation map. CV vectors are depicted per electrode. cm/s = centimeter/second; ms = milliseconds; BB = Bachmann’s Bundle; CT = conduction time; IVC = inferior vena cava; L = length; LA = left atrium; LAA = left atrial appendage; LAT = local activation time; PVA = pulmonary vein area; PVL = left pulmonary vein; PVR = right pulmonary vein; RA = right atrium; RAA = right atrial appendage; SVC = superior vena cava.

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  Figure 2. CV in patients with and without a history of AF. (a) biatrial CV histograms of patients with and without a history of AF; (b) biatrial median CV displayed for each patient (c) median CV displayed for each patient per region separately. *Non-normally distributed. cm/s = centimeter/second; CV = conduction velocity; AF = atrial fibrillation; BB = Bachmann’s Bundle; LA = left atrium; PVA = pulmonary vein area; RA = right atrium.

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  Figure 3. Color-coded activation maps and corresponding CV histograms at BB of a patient with and without a history of AF. The upper panel shows two examples of a color-coded activation maps at BB obtained from a patient with a history of AF (a) and a patient without a history of AF (b). Corresponding CV maps are depicted next to the activation map. CV vectors are depicted per electrode. In the patient with AF, a large area of slowing of conduction is present in the lower part of the activation map, represented by crowding of isochrones. The colored boxes indicate smooth wavefront propagation (pink rectangle) and local conduction heterogeneities (yellow, red and orange rectangles). In the patient without AF, the sinus rhythm wavefront encounters only some small areas of conduction delay (orange and red rectangles). Isochrones (black lines) drawn at 10 ms. The black arrows indicates the main wave direction. Lower panel: corresponding CV histograms of the patient with AF (a) and without AF (b) recorded at BB. The dashed lines represent the 5th, 50th and 95th percentiles of the relative frequency distribution of CVs. cm/s = centimeter/second; ms = milliseconds; BB = Bachmann’s bundle; CV =…

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  Figure 4. CV histograms of the AF and no AF group. Relative frequency distributions of CVs in the AF (a) and no AF group (b) shown for each location separately. cm/s = centimeter/second; AF = atrial fibrillation; BB = Bachmann’s Bundle; LA = left atrium; PVA = pulmonary vein area; RA = right atrium.

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  Figure 5. Predilection site for the lowest CV (a) Location of the lowest CV (defined as the 5th percentile of the relative frequency distribution of CV), within each AF patient (left) and no AF patient (right); (b) Distribution of the lowest CVs shown for each location separately. cm/s = centimeter/second; AF = atrial fibrillation; BB = Bachmann’s Bundle; LA = left atrium; PVA = pulmonary vein area; RA = right atrium.

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  Figure 6. TAT displayed for each individual patient for the entire atria and per region separately (a) Biatrial TAT displayed for each individual patient; (b) TAT displayed for each patient per region separately. * Non-normally distributed. ms = milliseconds; BB = Bachmann’s Bundle; LA = left atrium; PVA = pulmonary vein area; TAT = total activation time; RA = right atrium.