title: Mapping of atrial activation during sustained atrial fibrillation in dogs with rapid ventricular pacing induced heart failure: evidence for a role of driver regions.
abstract: BACKGROUND
  Dogs with rapid ventricular pacing (RVP)-induced congestive heart failure (CHF) have inducible atrial tachycardia, flutter, and fibrillation (AF). We tested the hypothesis that rapid atrial activation in multiple regions and at different rates is responsible for sustained AF in this CHF model.
  
  
  RESULTS
  We studied 12 episodes of sustained (>10 minutes) AF induced in 12 dogs with CHF produced by 3-6 weeks of RVP at 230 beats/minute. High-density mapping of AF was performed using 382 unipolar atrial electrograms recorded simultaneously from epicardial electrodes on the right (RA) and left atria (LA) and Bachmann's bundle. AF mechanisms were based on Fast Fourier Transform (FFT) analysis and activation sequence mapping. A driver was defined as a rapid stable activation region with a single dominant frequency peak in FFT analysis. During AF, three FFT and activation patterns were seen: (1) a single LA driver (7.8 +/- 1.1 Hz) near the pulmonary veins (PVs) with irregular activation in the rest of the atria (n = 4); (2) simultaneous, multisite, biatrial drivers at differing frequencies (LA vs RA dominant frequency gradient: 1.3 +/- 0.8 Hz) near the PVs (8.4 +/- 0.3 Hz) and high RA (8.5 +/- 1.5 Hz) (n = 7); and (3) biatrial irregular activation with multiple and/or broadband frequency peaks without a dominant frequency. (LA: 7.1-11.4 Hz; RA: 5.9-7.7 Hz) (n = 1). Atrial drivers had either a focal activation pattern or were due to a macroreentrant circuit around the PVs.
  
  
  CONCLUSIONS
  In this CHF model, FFT analysis and activation sequence mapping demonstrate that sustained AF is characterized by single and multiple, stable LA and RA drivers with predominant sources in the PVs and high RA causing fibrillatory conduction.
authors.affiliation: Department of Biomedical Engineering, University Hospitals of Cleveland, Cleveland, Ohio 44106, USA. bss4@cwru.edu
authors.forename: Kyungmoo
authors.initials: K
authors.lastname: Ryu
authors.forename: Sunil C
authors.initials: SC
authors.lastname: Shroff
authors.forename: Jayakumar
authors.initials: J
authors.lastname: Sahadevan
authors.forename: Nichole L
authors.initials: NL
authors.lastname: Martovitz
authors.forename: Celeen M
authors.initials: CM
authors.lastname: Khrestian
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Stambler
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000503:physiopathology*; D006328:Cardiac Catheterization; D002304:Cardiac Pacing, Artificial; D004285:Dogs; D022062:Electrophysiologic Techniques, Cardiac; D006325:Heart Atria / Q000503:physiopathology*; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology*; D023421:Models, Animal; D013997:Time Factors