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J Am Coll Cardiol, 2006; 47:2005-2012, doi:10.1016/j.jacc.2005.12.068 (Published online 20 April 2006).
© 2006 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Sites of Focal Atrial Activity Characterized by Endocardial Mapping During Atrial Fibrillation

Yoshihide Takahashi, MD*, Mélèze Hocini, MD, Mark D. O’Neill, MB, BCh, DPhil1, Prashanthan Sanders, MBBS, PhD2,6, Martin Rotter, MD3,7, Thomas Rostock, MD4, Anders Jonsson, MD5, Frédéric Sacher, MD, Jacques Clémenty, MD, Pierre Jaïs, MD6 and Michel Haïssaguerre, MD6

Hôpital Cardiologique du Haut-Lévêque–Université Victor Segalen Bordeaux 2, Bordeaux, France

Manuscript received November 1, 2005; revised manuscript received December 7, 2005, accepted December 19, 2005.

* Reprint requests and correspondence: Dr. Yoshihide Takahashi, Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604.Bordeaux-Pessac, France. (Email: yoshihide.takahashi{at}wanadoo.fr).

OBJECTIVES: The aim of the present study was to assess the feasibility of identifying sites of focal atrial activity by localized high-density endocardial mapping during atrial fibrillation (AF).

BACKGROUND: Sites of focal activity in the left atrium have been demonstrated by epicardial mapping during AF.

METHODS: Twenty-four patients (15 with paroxysmal, 3 with persistent, and 6 with permanent AF) underwent endocardial mapping during AF. A 20-pole catheter with five radiating spines was used to map both atria for 30 s in each of 10 pre-determined segments. A focal activity was defined as ≥3 atrial cycles with activation spreading from center to periphery of the mapping catheter. Catheter ablation was performed independent of the mapping results.

RESULTS: Spontaneous focal activities were observed in 13 sites in the left atrium (9%; anterior 1, roof 2, posterior 6, inferior 4) in 12 patients (9 paroxysmal, 3 persistent). Focal activity was observed continuously (two sites) or intermittently (11 sites, median 5 episodes), and associated with shortening of the cycle length (from 183 ± 33 ms to 172 ± 29 ms; p < 0.05). The mean duration of an intermittent episode was 1.5 s (range 0.4 to 7.1 s). Atrial fibrillation terminated without ablation at the foci in all of 12 patients, but in 2 of them, re-initiated arrhythmia was successfully ablated at these foci. Nine of these 12 patients (75%) were arrhythmia-free without antiarrhythmic drugs during a follow-up period of 7.0 ± 3.1 months.

CONCLUSIONS: Termination of AF without ablation at the sites of atrial focal activity suggests that this activity may be triggered by impulses originating from other regions, such as the pulmonary veins.

Abbreviations and Acronyms
  AF = atrial fibrillation
  LA = left atrium
  PV = pulmonary vein
  RA = right atrium
  RF = radiofrequency
  SVC = superior vena cava






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