Sites of Focal Atrial Activity Characterized by Endocardial Mapping During Atrial Fibrillation
Yoshihide Takahashi, MD*,
Mélèze Hocini, MD,
Mark D. O'Neill, MB, BCh, DPhil,
Prashanthan Sanders, MBBS, PhD,
Martin Rotter, MD,
Thomas Rostock, MD,
Anders Jonsson, MD,
Frédéric Sacher, MD,
Jacques Clémenty, MD,
Pierre Jaïs, MD and
Michel Haïssaguerre, MD
Hôpital Cardiologique du Haut-Lévêque–Université Victor Segalen Bordeaux 2, Bordeaux, France
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Figure 1 (A) A 20-pole multispine catheter. The spine A and B being recognized by radio-opaque markers (circled) for visualization with fluoroscopy. The marker on spine A is proximal to the external two electrodes, and on spine B distal to the internal two electrodes. (B) A multispine catheter deployed in the inferior left atrium. Quadripolar catheters are deployed in the left atrium and coronary sinus.
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Figure 2 Passive activation demonstrated by two-dimensional mapping. The earliest activation was recorded on the external bipole of spine C (*) and the latest activation on the external bipole on spines A and E. A single wave front enters into the mapping area from spine C (*) and exits from spines A and E (right). This activation sequence was observed in three consecutive beats.
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Figure 3 Chaotic activation demonstrated by two-dimensional mapping. The activation sequence changes beat-to-beat. The analysis of wave front propagation was prevented by the presence of double potentials and fractionated potentials.
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Figure 4 Centrifugal activation demonstrated by two-dimensional mapping. Activity on the internal bipole precedes that on the external bipole in each spine, indicating focal activity in the center of the mapping area. This activation sequence is observed in four consecutive beats.
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Figure 5 Episode of continuous centrifugal activation.
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Figure 6 The regional incidence of chaotic activation for the six areas mapped in each patient. LA = left atrium.
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Figure 7 Schema demonstrating the location of atrial focal activity. Blue dots indicate the site of continuous activity, and red dots indicate the sites where additional ablation was performed.
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Figure 8 Episode of centrifugal activation. Centrifugal activation (internal to external propagation in each spine) is observed in eight consecutive beats (*). The duration of this episode is 1,100 ms. Cycle length decreases during the episode of centrifugal activation pattern, from 170 to 157 ms.
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