Background-Specific noninvasive signal processing was applied to identify drivers in distinct categories of persistent atrial fibrillation (AF). Methods and Results-In 103 consecutive patients with persistent AF, accurate biatrial geometry relative to an array of 252 body surface electrodes was obtained from a noncontrast computed tomography scan. The reconstructed unipolar AF electrograms acquired at bedside from multiple windows (duration, 9 +/- 1 s) were signal processed to identify the drivers (focal or reentrant activity) and their cumulative density map. The driver domains were catheter ablated by using AF termination as the procedural end point in comparison with the stepwise-ablation control group. The maps showed incessantly changing beat-to-beat wave fronts and varying spatiotemporal behavior of driver activities. Reentries were not sustained (median, 2.6 rotations lasting 449 +/- 89 ms), meandered substantially but recurred repetitively in the same region. In total, 4720 drivers were identified in 103 patients: 3802 (80.5%) reentries and 918 (19.5%) focal breakthroughs; most of them colocalized. Of these, 69% reentries and 71% foci were in the left atrium. Driver ablation alone terminated 75% and 15% of persistent and long-lasting AF, respectively. The number of targeted driver regions increased with the duration of continuous AF: 2 in patients presenting in sinus rhythm, 3 in AF lasting 1 to 3 months, 4 in AF lasting 4 to 6 months, and 6 in AF lasting longer. The termination rate sharply declined after 6 months. The mean radiofrequency delivery to AF termination was 28 +/- 17 minutes versus 65 +/- 33 minutes in the control group (P<0.0001). At 12 months, 85% patients with AF termination were free from AF, similar to the control population (87%,); P=not significant. Conclusions-Persistent AF in early months is maintained predominantly by drivers clustered in a few regions, most of them being unstable reentries.
机构:
Washington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Washington Univ, Cardiac Bioelect & Arrhythmia Ctr, St Louis, MO USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Cuculich, Phillip S.
;
Wang, Yong
论文数: 0引用数: 0
h-index: 0
机构:
Washington Univ, Cardiac Bioelect & Arrhythmia Ctr, St Louis, MO USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Wang, Yong
;
Lindsay, Bruce D.
论文数: 0引用数: 0
h-index: 0
机构:
Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH 44106 USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Lindsay, Bruce D.
;
Faddis, Mitchell N.
论文数: 0引用数: 0
h-index: 0
机构:
Washington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Washington Univ, Cardiac Bioelect & Arrhythmia Ctr, St Louis, MO USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Faddis, Mitchell N.
;
Schuessler, Richard B.
论文数: 0引用数: 0
h-index: 0
机构:
Washington Univ, Sch Med, Div Cardiothorac Surg, St Louis, MO 63110 USA
Washington Univ, Cardiac Bioelect & Arrhythmia Ctr, St Louis, MO USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Schuessler, Richard B.
;
Damiano, Ralph J., Jr.
论文数: 0引用数: 0
h-index: 0
机构:
Washington Univ, Sch Med, Div Cardiothorac Surg, St Louis, MO 63110 USA
Washington Univ, Cardiac Bioelect & Arrhythmia Ctr, St Louis, MO USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Damiano, Ralph J., Jr.
;
Li, Li
论文数: 0引用数: 0
h-index: 0
机构:
Washington Univ, Cardiac Bioelect & Arrhythmia Ctr, St Louis, MO USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Li, Li
;
Rudy, Yoram
论文数: 0引用数: 0
h-index: 0
机构:
Washington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Washington Univ, Cardiac Bioelect & Arrhythmia Ctr, St Louis, MO USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, France
Univ Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, GermanyHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Jadidi, Amir S.
;
Cochet, Hubert
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Cochet, Hubert
;
Shah, Ashok J.
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Shah, Ashok J.
;
Kim, Steven J.
论文数: 0引用数: 0
h-index: 0
机构:
St Jude Med, St Paul, MN USAHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Kim, Steven J.
;
Duncan, Edward
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Duncan, Edward
;
Miyazaki, Shinsuke
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Miyazaki, Shinsuke
;
Sermesant, Maxime
论文数: 0引用数: 0
h-index: 0
机构:
INRIA, Asklepios Project, Sophia Antipolis, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Sermesant, Maxime
;
Lehrmann, Heiko
论文数: 0引用数: 0
h-index: 0
机构:
Univ Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, GermanyHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Lehrmann, Heiko
;
Lederlin, Matthieu
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Lederlin, Matthieu
;
Linton, Nick
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Linton, Nick
;
Forclaz, Andrei
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Forclaz, Andrei
;
Nault, Isabelle
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Nault, Isabelle
;
Rivard, Lena
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Rivard, Lena
;
论文数: 引用数:
h-index:
机构:
Wright, Matthew
;
Liu, Xingpeng
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Liu, Xingpeng
;
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机构:
Scherr, Daniel
;
Wilton, Stephen B.
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Wilton, Stephen B.
;
Roten, Laurent
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Roten, Laurent
;
论文数: 引用数:
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机构:
Pascale, Patrizio
;
论文数: 引用数:
h-index:
机构:
Derval, Nicolas
;
Sacher, Frederic
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Sacher, Frederic
;
Knecht, Sebastien
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Knecht, Sebastien
;
Keyl, Cornelius
论文数: 0引用数: 0
h-index: 0
机构:
Univ Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, GermanyHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Keyl, Cornelius
;
论文数: 引用数:
h-index:
机构:
Hocini, Meleze
;
论文数: 引用数:
h-index:
机构:
Montaudon, Michel
;
Laurent, Francois
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Laurent, Francois
;
Haissaguerre, Michel
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Haissaguerre, Michel
;
Jais, Pierre
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
机构:
Univ Calif San Francisco, Cardiac Electrophysiol Sect, Dept Med, San Francisco, CA 94143 USAUniv Calif San Francisco, Cardiac Electrophysiol Sect, Dept Med, San Francisco, CA 94143 USA
Kim, Albert M.
;
Olgin, Jeffrey E.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Calif San Francisco, Cardiac Electrophysiol Sect, Dept Med, San Francisco, CA 94143 USAUniv Calif San Francisco, Cardiac Electrophysiol Sect, Dept Med, San Francisco, CA 94143 USA
Olgin, Jeffrey E.
;
Everett, Thomas H.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Calif San Francisco, Cardiac Electrophysiol Sect, Dept Med, San Francisco, CA 94143 USAUniv Calif San Francisco, Cardiac Electrophysiol Sect, Dept Med, San Francisco, CA 94143 USA
机构:
Washington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Washington Univ, Cardiac Bioelect & Arrhythmia Ctr, St Louis, MO USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Cuculich, Phillip S.
;
Wang, Yong
论文数: 0引用数: 0
h-index: 0
机构:
Washington Univ, Cardiac Bioelect & Arrhythmia Ctr, St Louis, MO USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Wang, Yong
;
Lindsay, Bruce D.
论文数: 0引用数: 0
h-index: 0
机构:
Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH 44106 USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Lindsay, Bruce D.
;
Faddis, Mitchell N.
论文数: 0引用数: 0
h-index: 0
机构:
Washington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Washington Univ, Cardiac Bioelect & Arrhythmia Ctr, St Louis, MO USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Faddis, Mitchell N.
;
Schuessler, Richard B.
论文数: 0引用数: 0
h-index: 0
机构:
Washington Univ, Sch Med, Div Cardiothorac Surg, St Louis, MO 63110 USA
Washington Univ, Cardiac Bioelect & Arrhythmia Ctr, St Louis, MO USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Schuessler, Richard B.
;
Damiano, Ralph J., Jr.
论文数: 0引用数: 0
h-index: 0
机构:
Washington Univ, Sch Med, Div Cardiothorac Surg, St Louis, MO 63110 USA
Washington Univ, Cardiac Bioelect & Arrhythmia Ctr, St Louis, MO USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Damiano, Ralph J., Jr.
;
Li, Li
论文数: 0引用数: 0
h-index: 0
机构:
Washington Univ, Cardiac Bioelect & Arrhythmia Ctr, St Louis, MO USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Li, Li
;
Rudy, Yoram
论文数: 0引用数: 0
h-index: 0
机构:
Washington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
Washington Univ, Cardiac Bioelect & Arrhythmia Ctr, St Louis, MO USAWashington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, France
Univ Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, GermanyHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Jadidi, Amir S.
;
Cochet, Hubert
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Cochet, Hubert
;
Shah, Ashok J.
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Shah, Ashok J.
;
Kim, Steven J.
论文数: 0引用数: 0
h-index: 0
机构:
St Jude Med, St Paul, MN USAHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Kim, Steven J.
;
Duncan, Edward
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Duncan, Edward
;
Miyazaki, Shinsuke
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Miyazaki, Shinsuke
;
Sermesant, Maxime
论文数: 0引用数: 0
h-index: 0
机构:
INRIA, Asklepios Project, Sophia Antipolis, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Sermesant, Maxime
;
Lehrmann, Heiko
论文数: 0引用数: 0
h-index: 0
机构:
Univ Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, GermanyHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Lehrmann, Heiko
;
Lederlin, Matthieu
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Lederlin, Matthieu
;
Linton, Nick
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Linton, Nick
;
Forclaz, Andrei
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Forclaz, Andrei
;
Nault, Isabelle
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Nault, Isabelle
;
Rivard, Lena
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Rivard, Lena
;
论文数: 引用数:
h-index:
机构:
Wright, Matthew
;
Liu, Xingpeng
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Liu, Xingpeng
;
论文数: 引用数:
h-index:
机构:
Scherr, Daniel
;
Wilton, Stephen B.
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Wilton, Stephen B.
;
Roten, Laurent
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Roten, Laurent
;
论文数: 引用数:
h-index:
机构:
Pascale, Patrizio
;
论文数: 引用数:
h-index:
机构:
Derval, Nicolas
;
Sacher, Frederic
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Sacher, Frederic
;
Knecht, Sebastien
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Knecht, Sebastien
;
Keyl, Cornelius
论文数: 0引用数: 0
h-index: 0
机构:
Univ Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, GermanyHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Keyl, Cornelius
;
论文数: 引用数:
h-index:
机构:
Hocini, Meleze
;
论文数: 引用数:
h-index:
机构:
Montaudon, Michel
;
Laurent, Francois
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Laurent, Francois
;
Haissaguerre, Michel
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
Haissaguerre, Michel
;
Jais, Pierre
论文数: 0引用数: 0
h-index: 0
机构:
Hop Cardiol Haut Leveque, F-33604 Bordeaux, France
Univ Bordeaux 2, F-33076 Bordeaux, FranceHop Cardiol Haut Leveque, F-33604 Bordeaux, France
机构:
Univ Calif San Francisco, Cardiac Electrophysiol Sect, Dept Med, San Francisco, CA 94143 USAUniv Calif San Francisco, Cardiac Electrophysiol Sect, Dept Med, San Francisco, CA 94143 USA
Kim, Albert M.
;
Olgin, Jeffrey E.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Calif San Francisco, Cardiac Electrophysiol Sect, Dept Med, San Francisco, CA 94143 USAUniv Calif San Francisco, Cardiac Electrophysiol Sect, Dept Med, San Francisco, CA 94143 USA
Olgin, Jeffrey E.
;
Everett, Thomas H.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Calif San Francisco, Cardiac Electrophysiol Sect, Dept Med, San Francisco, CA 94143 USAUniv Calif San Francisco, Cardiac Electrophysiol Sect, Dept Med, San Francisco, CA 94143 USA