title: Two Independent Mapping Techniques Identify Rotational Activity Patterns at Sites of Local Termination During Persistent Atrial Fibrillation.
abstract: BACKGROUND
  The mechanisms for atrial fibrillation (AF) are unclear in part because diverse mapping techniques yield diverse maps, ranging from stable organized sources to highly disordered waves. We hypothesized that AF mechanisms may be clarified if mapping techniques were compared in the same patients, and referenced to a clinical endpoint. We compared two independent AF mapping techniques in patients in whom ablation terminated persistent AF before pulmonary vein isolation (PVI).
  
  
  RESULTS
  We identified 12 patients with persistent AF (61.2 ± 10.8 years, four female) in whom mapping with 64 pole baskets and technique 1 (activation/phase mapping, FIRM) identified rotational activation patterns during at least 50% of the 4-second mapping interval and targeted ablation at these rotational sites terminated AF to sinus rhythm (n = 10) or atrial tachycardia. We analyzed the unipolar electrograms of these patients to determine phase maps of activation by an independent technique 2 (Kuklik, Schotten et al., IEEE Trans Biomed Eng 2015). Compared to technique 1, technique 2 revealed a source in 12 of 12 (100%) cases with spatial concordance in all cases (P <0.05) and similar rotational characteristics.
  
  
  CONCLUSIONS
  At sites where ablation terminated persistent AF, two independent mapping techniques identified stable rotational activation for multiple cycles that drove peripheral disorder. Future comparative studies referenced to a clinical endpoint may help reconcile if discrepancies between AF mapping studies reports represent techniques, patient populations or models of AF, and improve mapping to better guide ablation.
authors.affiliation: Department of Medicine/Division of Cardiology, Stanford University, Stanford, California, USA.
authors.forename: Mahmood
authors.initials: M
authors.lastname: Alhusseini
authors.affiliation: Department of Physics, University of California, San Diego, California, USA.
authors.forename: David
authors.initials: D
authors.lastname: Vidmar
authors.affiliation: Department of Medicine/Division of Cardiology, Stanford University, Stanford, California, USA.
authors.forename: Gabriela L
authors.initials: GL
authors.lastname: Meckler
authors.affiliation: Department of Medicine/Division of Cardiology, Stanford University, Stanford, California, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Kowalewski
authors.affiliation: Department of Medicine/Division of Cardiology, Stanford University, Stanford, California, USA.
authors.forename: Fatemah
authors.initials: F
authors.lastname: Shenasa
authors.affiliation: Department of Medicine/Division of Cardiology, Stanford University, Stanford, California, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Wang
authors.affiliation: Department of Medicine/Division of Cardiology, Stanford University, Stanford, California, USA.
authors.forename: Sanjiv M
authors.initials: SM
authors.lastname: Narayan
authors.affiliation: Department of Physics, University of California, San Diego, California, USA.
authors.forename: Wouter-Jan
authors.initials: WJ
authors.lastname: Rappel
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery; D012815:Signal Processing, Computer-Assisted; D016896:Treatment Outcome
keywords: FIRM; atrial fibrillation; catheter ablation; human; phase mapping; rotor mapping