title: Identification of Dominant Excitation Patterns and Sources of Atrial Fibrillation by Causality Analysis.
abstract: Burden of atrial fibrillation (AF) can be reduced by ablation of sources of electrical impulses driving AF but driver identification is still challenging. This study presents a new methodology based on causality analysis that allows identifying the hierarchically dominant areas driving AF. Identification of dominant propagation patterns was achieved by computing causal relations between intracardiac multi-electrode catheter recordings of four paroxysmal AF patients during sinus rhythm, pacing and AF. In addition, realistic mathematical models of the atria during AF were used to validate the methodology both in the presence and absence of dominant frequency (DF) gradients. During electrical pacing, sources of propagation patterns detected by causality analysis were consistent with the location of the stimulating catheter. During AF, propagation patterns presented temporal variability, but a dominant direction accounted for significantly more propagations than other directions (49 ± 15% vs. 14 ± 13% or less, p < 0.01). Both in patients with a DF gradient and in mathematical models, causal maps allowed the identification of sites responsible for maintenance of AF. Causal maps allowed the identification of atrial dominant sites. In particular, causality analysis resulted in stable dominant cause-effect propagation directions during AF and could serve as a guide for performing ablation procedures in AF patients.
authors: ITACA, Universitat Politècnica de Valencia, 1ªplanta, Edificio 8G, Ciudad Politécnica de la Innovación, Camino de Vera s/n, 46022, Valencia, Spain.
authors: Miguel
authors: M
authors: Rodrigo
authors: Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Calle Dr Esquerdo 46, 28007, Madrid, Spain.
authors: Andreu M
authors: AM
authors: Climent
authors: ITACA, Universitat Politècnica de Valencia, 1ªplanta, Edificio 8G, Ciudad Politécnica de la Innovación, Camino de Vera s/n, 46022, Valencia, Spain.
authors: Alejandro
authors: A
authors: Liberos
authors: Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Calle Dr Esquerdo 46, 28007, Madrid, Spain.|Hospital Universitario Central de Asturias, Avd de Roma sn, 33006, Oviedo, Spain.
authors: David
authors: D
authors: Calvo
authors: Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Calle Dr Esquerdo 46, 28007, Madrid, Spain.|Facultad de Medicina, Universidad Complutense de Madrid, Pza. Ramón y Cajal, s/n, Ciudad Universitaria, 28040, Madrid, Spain.
authors: Francisco
authors: F
authors: Fernández-Avilés
authors: Center for Arrhythmia Research, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
authors: Omer
authors: O
authors: Berenfeld
authors: Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Calle Dr Esquerdo 46, 28007, Madrid, Spain.|Facultad de Medicina, Universidad Complutense de Madrid, Pza. Ramón y Cajal, s/n, Ciudad Universitaria, 28040, Madrid, Spain.
authors: Felipe
authors: F
authors: Atienza
authors: ITACA, Universitat Politècnica de Valencia, 1ªplanta, Edificio 8G, Ciudad Politécnica de la Innovación, Camino de Vera s/n, 46022, Valencia, Spain. guisan@eln.upv.es.
authors: Maria S
authors: MS
authors: Guillem
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008955:Models, Cardiovascular
keywords: Ablation; Atrial fibrillation; Dominant pattern; Granger causality; Hierarchical pattern