title: Spatial Relationship of Focal Impulses, Rotors and Low Voltage Zones in Patients With Persistent Atrial Fibrillation.
abstract: Focal impulses (FI) and rotors are sources associated with the initiation and maintenance of atrial fibrillation (AF). Their ablation results in a lower recurrence rate. The aim of this study was to characterize for the first time the spatial relationship between such sources and atrial low voltage zones (LVZ) representing fibrosis.
  
  
  
  Twenty-five consecutive patients undergoing their first ablation for persistent AF were included. Voltage mapping of both atria was done during AF. Endocardial mapping of FI and rotors (sources) was performed using a basket catheter and displayed using RhythmView(TM) (Topera Inc.) before ablation. Spatial relationship of LVZ and sources was analyzed.
  
  
  
  LVZs covered 13 ± 12% of right atrial (RA) endocardial surface and 33 ± 25% of left atrial (LA) endocardial surface. The median number of sources was 1 [1-3] in RA and 3 [1-4] in LA. Of LA sources, 18 (30%) were definitely not associated with LVZs or pulmonary vein (PV) antra. Of RA sources, 32 (84%) were remote from LVZ. During ablation of such sources substantial cycle length (CL) prolongation or AF conversion occurred in 11/23 patients (48%). Altogether, 8/11 (73%) of these pertinent sources were located remotely from LVZ and PV antra.
  
  
  
  There is a wide discrepancy in distribution of LVZ areas and sites of identified rotors. Site and incidence of FIRM sources appear to be unpredictable with atrial substrate mapping. Further prospective, randomized studies are necessary to elucidate the impact of additional ablation of such sources in patients with persistent or longstanding persistent AF.
authors.affiliation: Helios Clinic Erfurt, Clinic for Cardiology/Department of Interventional Electrophysiology, Erfurt, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Schade
authors.affiliation: Heart Center Bad Neustadt, Department of Interventional Electrophysiology, Bad Neustadt/Saale, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Nentwich
authors.affiliation: Helios Research Center, Erfurt, Germany.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Costello-Boerrigter
authors.affiliation: Heart Center Bad Neustadt, Department of Interventional Electrophysiology, Bad Neustadt/Saale, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Halbfass
authors.affiliation: Heart Center Bad Neustadt, Department of Interventional Electrophysiology, Bad Neustadt/Saale, Germany.|Ruhr-University Bochum, Faculty of Medicine, Bochum, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Mueller
authors.affiliation: Heart Center Bad Neustadt, Department of Interventional Electrophysiology, Bad Neustadt/Saale, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Roos
authors.affiliation: Heart Center Bad Neustadt, Department of Interventional Electrophysiology, Bad Neustadt/Saale, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Barth
authors.affiliation: Heart Center Bad Neustadt, Department of Interventional Electrophysiology, Bad Neustadt/Saale, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Krug
authors.affiliation: Heart Center Bad Neustadt, Department of Interventional Electrophysiology, Bad Neustadt/Saale, Germany.
authors.forename: Geza-Atilla
authors.initials: GA
authors.lastname: Szoelloesi
authors.affiliation: Helios Clinic Erfurt, Clinic for Cardiology/Department of Interventional Electrophysiology, Erfurt, Germany.|Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Lapp
authors.affiliation: Heart Center Bad Neustadt, Department of Interventional Electrophysiology, Bad Neustadt/Saale, Germany.|Ruhr-University Bochum, Faculty of Medicine, Bochum, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Deneke
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005355:Fibrosis; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D006329:Heart Conduction System / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: ablation; atrial fibrillation; low voltage; rotor; termination