title: Organized Sources Are Spatially Conserved in Recurrent Compared to Pre-Ablation Atrial Fibrillation: Further Evidence for Non-Random Electrical Substrates.
abstract: Recurrent atrial fibrillation (AF) after ablation is associated with reconnection of initially isolated pulmonary vein (PV) trigger sites. Substrates are often targeted in addition to PVI, but it is unclear how substrates progress over time. We studied if substrates in recurrent AF are conserved or have developed de novo from pre-ablation AF.
  
  
  
  Of 137 patients undergoing Focal Impulse and Rotor Mapping (FIRM) at their index procedure for AF, 29 consecutive patients (60 ± 8 years, 79% persistent) recurred and were also mapped at repeat procedure (21 ± 20 months later) using carefully placed 64-pole baskets and RhythmView(TM) (Topera, Menlo Park, CA, USA) to identify AF sources and disorganized zones. Compared to index AF, recurrent AF had a longer cycle length (177 ± 21 vs. 167 ± 19 milliseconds, P = 0.01). All patients (100%) had 1 or more conserved AF rotors between procedures with surrounding disorganization. The number of sources was similar for recurrent AF post-PVI versus index AF (3.2 ± 1.4 vs. 3.1 ± 1.0, P = 0.79), but was lower for recurrent AF after FIRM+PVI versus index AF (4.4 ± 1.4 vs. 2.9 ± 1.7, P = 0.03). Overall, 81% (61/75) of AF sources lay in conserved regions, while 19% (14/75) were detected de novo.
  
  
  
  Electrical propagation patterns for recurrent AF after unsuccessful ablation are similar in individual patients to their index AF. These data support temporospatial stability of AF substrates over 1-2 years. Trials should determine the relative benefit of adding substrate mapping and ablation to PVI for recurrent AF.
authors.affiliation: Kaiser Permanente, San Diego, California, USA.
authors.forename: Gautam G
authors.initials: GG
authors.lastname: Lalani
authors.affiliation: University of Cambridge, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Coysh
authors.affiliation: University of California Medical Center, San Diego, California, USA.|Stanford University, Palo Alto, California, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Baykaner
authors.affiliation: Stanford University, Palo Alto, California, USA.
authors.forename: Junaid
authors.initials: J
authors.lastname: Zaman
authors.affiliation: Veterans' Affairs Medical Center, San Diego, California, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hopper
authors.affiliation: University of California Medical Center, San Diego, California, USA.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Schricker
authors.affiliation: University of California Medical Center, San Diego, California, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Trikha
authors.affiliation: University of California Medical Center, San Diego, California, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.affiliation: University of California Medical Center, San Diego, California, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Krummen
authors.affiliation: Stanford University, Palo Alto, California, USA.
authors.forename: Sanjiv M
authors.initials: SM
authors.lastname: Narayan
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D017211:Treatment Failure
keywords: FIRM ablation; atrium; fibrillation; focal sources; human; rotors