title: Dynamics of Endo- and Epicardial Focal Fibrillation Waves at the Right Atrium in a Patient With Advanced Atrial Remodelling.
abstract: Focal waves appear frequently at the epicardium during persistent atrial fibrillation (AF), however, the origin of these waves is under debate. We performed simultaneous endo-epicardial mapping of the right atrial wall during longstanding persistent AF in a patient undergoing cardiac surgery. During 10 seconds 53 and 59 focal waves appeared at random at respectively the endocardium and epicardium. Repetitive focal activity did not last longer than 3 cycles. Transmural asynchrony and conduction might be the origin of focal waves. Asynchronous propagation of fibrillation waves in 3 dimensions would stabilize the arrhythmia and could explain the limited success of persistent AF ablation.
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Lisette J M E
authors.initials: LJ
authors.lastname: van der Does
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Charles
authors.initials: C
authors.lastname: Kik
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
authors.affiliation: Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands.
authors.forename: Maurits A
authors.initials: MA
authors.lastname: Allessie
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: n.m.s.degroot@erasmusmc.nl.
authors.forename: Natasja M S
authors.initials: NM
authors.lastname: de Groot
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology*; D064752:Atrial Remodeling / Q000502:physiology*; D018780:Body Surface Potential Mapping; D004699:Endocardium / Q000503:physiopathology*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D010496:Pericardium / Q000503:physiopathology*