title: Complexity and Distribution of Drivers in Relation to Duration of Persistent Atrial Fibrillation.
abstract: BACKGROUND
  The underlying mechanisms sustaining human persistent atrial fibrillation (PsAF) is poorly understood.
  
  
  OBJECTIVE
  This study sought to investigate the complexity and distribution of AF drivers in PsAF of varying durations.
  
  
  METHODS
  Of 135 consecutive patients with PsAF, 105 patients referred for de novo ablation of PsAF were prospectively recruited. Patients were divided into 3 groups according to AF duration: PsAF presenting in sinus rhythm (AF induced), PsAF <12 months, and PsAF >12 months. Patients wore a 252-electrode vest for body surface mapping. Localized drivers (re-entrant or focal) were identified using phase-mapping algorithms.
  
  
  RESULTS
  In this patient cohort, the most prominent re-entrant driver regions included the pulmonary vein (PV) regions and inferoposterior left atrial wall. Focal drivers were observed in 1 or both PV regions in 75% of patients. Comparing between the 3 groups, with longer AF duration AF complexity increased, reflected by increased number of re-entrant rotations (p < 0.05), number of re-entrant rotations and focal events (p < 0.05), and number of regions harboring re-entrant (p < 0.01) and focal (p < 0.05) drivers. With increased AF duration, a higher proportion of patients had multiple extra-PV driver regions, specifically in the inferoposterior left atrium (p < 0.01), superior right atrium (p < 0.05), and inferior right atrium (p < 0.05). Procedural AF termination was achieved in 70% of patients, but decreased with longer AF duration.
  
  
  CONCLUSIONS
  The complexity of AF drivers increases with prolonged AF duration. Re-entrant and focal drivers are predominantly located in the PV antral and adjacent regions. However, with longer AF duration, multiple drivers are distributed at extra-PV sites. AF termination rate declines as patients progress to longstanding PsAF, underscoring the importance of early intervention.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France.
authors.forename: Han S
authors.initials: HS
authors.lastname: Lim
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France; INSERM U1045 - L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Bordeaux, France.
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France; INSERM U1045 - L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Bordeaux, France.
authors.forename: Remi
authors.initials: R
authors.lastname: Dubois
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France; INSERM U1045 - L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Bordeaux, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Denis
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France; INSERM U1045 - L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Bordeaux, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France.
authors.forename: Stephan
authors.initials: S
authors.lastname: Zellerhoff
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France.
authors.forename: Seigo
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Berte
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France.
authors.forename: Saagar
authors.initials: S
authors.lastname: Mahida
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France.
authors.forename: Matthew
authors.initials: M
authors.lastname: Daly
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Jesel
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France; INSERM U1045 - L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Bordeaux, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Pomier
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France; INSERM U1045 - L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Bordeaux, France.
authors.forename: Valentin
authors.initials: V
authors.lastname: Meillet
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France; INSERM U1045 - L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Bordeaux, France.
authors.forename: Sana
authors.initials: S
authors.lastname: Amraoui
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France.
authors.forename: Ashok J
authors.initials: AJ
authors.lastname: Shah
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France; INSERM U1045 - L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Bordeaux, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Cochet
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France; INSERM U1045 - L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Bordeaux, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sacher
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France; INSERM U1045 - L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, Bordeaux, France; INSERM U1045 - L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Bordeaux, France. Electronic address: michel.haissaguerre@chu-bordeaux.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: complexity; drivers; panoramic mapping; persistent atrial fibrillation