title: Atrial fibrillation driver mechanisms: Insight from the isolated human heart.
abstract: Although there have been great technological advances in the treatment of atrial fibrillation (AF), current therapies remain limited due to a narrow understanding of AF mechanisms in the human heart. This review will highlight our recent studies on explanted human hearts where we developed and employed a novel functional-structural mapping approach by integrating high-resolution simultaneous endo-epicardial and panoramic optical mapping with 3D gadolinium-enhanced MRI to define the spatiotemporal characteristics of AF drivers and their structural substrates. The results allow us to postulate that the primary mechanism of AF maintenance in human hearts is a limited number of localized intramural microanatomic reentrant AF drivers anchored to heart-specific 3D fibrotically insulated myobundle tracks, which may remain hidden to clinical single-surface electrode mapping. We suggest that ex vivo human heart studies, by using an integrated 3D functional and structural mapping approach, will help to reveal defining features of AF drivers as well as validate and improve clinical approaches to detect and target these AF drivers in patients with cardiac diseases.
authors: Department of Physiology & Cell Biology, Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210-1218.
authors: Thomas A
authors: TA
authors: Csepe
authors: Department of Physiology & Cell Biology, Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210-1218.
authors: Brian J
authors: BJ
authors: Hansen
authors: Department of Physiology & Cell Biology, Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 300 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210-1218. Electronic address: vadim.fedorov@osumc.edu.
authors: Vadim V
authors: VV
authors: Fedorov
mesh_terms: D000200:Action Potentials; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D017115:Catheter Ablation; D003287:Contrast Media; D005355:Fibrosis; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006339:Heart Rate; D006801:Humans; D021621:Imaging, Three-Dimensional; D000067268:Isolated Heart Preparation; D008279:Magnetic Resonance Imaging / Q000379:methods; D011237:Predictive Value of Tests; D012307:Risk Factors; D056969:Voltage-Sensitive Dye Imaging
chemical_list: D003287:Contrast Media
keywords: Atrial fibrillation; Catheter ablation; Fibrosis; Intramural microanatomic reentry; Optical mapping; Reentrant driver