September 21, 2010Circulation310 citationsOpen Access
Noninvasive Characterization of Epicardial Activation in Humans With Diverse Atrial Fibrillation Patterns
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Key Result
Noninvasive electrocardiographic imaging (ECGI) accurately mapped epicardial activation of atrial fibrillation with 6 mm spatial accuracy, identifying multiple wavelets as the most common pattern.
Study Design
Type
Observational (n=35)
Structured PICO
Can noninvasive electrocardiographic imaging (ECGI) accurately map epicardial activation patterns and characterize mechanisms of atrial fibrillation in humans?
P
Population
35 patients with diverse atrial fibrillation patterns (6 in testing phase for pacing, 3 for correlative observations, 26 in study phase for AF mapping)
I
Intervention
Noninvasive electrocardiographic imaging (ECGI)
C
Comparator
Invasive catheter mapping (CARTO) and ablation (in testing phase)
O
Outcome
Spatial accuracy of ECGI and characterization of AF mechanisms and complexitysurrogate
ECGI provides a noninvasive, patient-specific method to map epicardial activation patterns in AF, revealing diverse mechanisms and increasing complexity with longer AF duration.
Abstract
BACKGROUND: Various mechanisms of atrial fibrillation (AF) have been demonstrated experimentally. Invasive methods to study these mechanisms in humans have limitations, precluding continuous mapping of both atria with sufficient resolution. In this article, we present continuous biatrial epicardial activation sequences of AF in humans using noninvasive electrocardiographic imaging (ECGI). METHODS AND RESULTS: In the testing phase, ECGI accuracy was evaluated by comparing ECGI with co-registered CARTO images during atrial pacing in 6 patients. Additionally, correlative observations from catheter mapping and ablation were compared with ECGI in 3 patients. In the study phase, ECGI maps during AF in 26 patients were analyzed for mechanisms and complexity. ECGI noninvasively imaged the low-amplitude signals of AF in a wide range of patients (97 procedural success). Spatial accuracy for determining initiation sites from pacing was 6 mm. Locations critical to maintenance of AF identified during catheter ablation were identified by ECGI; ablation near these sites restored sinus rhythm. In the study phase, the most common patterns of AF were multiple wavelets (92), with pulmonary vein (69) and non-pulmonary vein (62) focal sites. Rotor activity was seen rarely (15). AF complexity increased with longer clinical history of AF, although the degree of complexity of nonparoxysmal AF varied widely. CONCLUSIONS: ECGI offers a noninvasive way to map epicardial activation patterns of AF in a patient-specific manner. The results highlight the coexistence of a variety of mechanisms and variable complexity among patients. Overall, complexity generally increased with duration of AF.
Cite This Study
Cuculich et al. (2010) conducted an observational in Atrial fibrillation (n=35). Noninvasive electrocardiographic imaging (ECGI) vs. Invasive catheter mapping (CARTO) was evaluated on Spatial accuracy and identification of atrial fibrillation mechanisms. Noninvasive electrocardiographic imaging (ECGI) accurately mapped epicardial activation of atrial fibrillation with 6 mm spatial accuracy, identifying multiple wavelets as the most common pattern.