Progressive modification of rotors in persistent atrial fibrillation by stepwise linear ablation Jichao Zhao, PhD, Yan Yao, MD, PhD, Rui Shi, MD, PhD,

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Presentation transcript:

Progressive modification of rotors in persistent atrial fibrillation by stepwise linear ablation Jichao Zhao, PhD, Yan Yao, MD, PhD, Rui Shi, MD, PhD, Wen Huang, MD, PhD, Bruce H. Smaill, PhD, Nigel A. Lever, MBChB, FRACP HeartRhythm Case Reports Volume 1, Issue 1, Pages 22-26 (January 2015) DOI: 10.1016/j.hrcr.2014.10.004 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Three-dimensional endocardial surface of the left atrium using coordinates provided by the EnSite system (St Jude Medical) was reconstructed at the anterior view (A), and a typical atrial virtual electrogram was processed by the proposed signal processing tools (B). Wavelet-based peak atrial impulse detection (the far-field ventricular activation complex is indicated in grey). I: Typical virtual electrogram of the patient with persistent atrial fibrillation at the posterior inferior septum. II: The electrogram is attenuated during the ventricular activation time window. III: Wavelet scalogram of panel II, indicating the magnitude and duration of each of the 15 scales. White indicates a negative deflection and black a positive deflection. IV: Derivative signal constructed from 7 lowest wavelet scales. The maxima for which adjacent derivative gradients exceed a preset threshold are indicated by closed circles, with the peak-to-peak distance ≥70 ms. Where peaks are separated by <70 ms, the peak with the highest derivative gradient was identified as local activation (closed circles) and others as fractionation (open circles). ASS = anterior superior septum; LAA = left atrium appendage; LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; MV = mitral valve; PIS = persistent atrial fibrillation; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein. HeartRhythm Case Reports 2015 1, 22-26DOI: (10.1016/j.hrcr.2014.10.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 Regional frequency maps rendered on the anterior LA wall immediately before (A) and during (B and C) linear ablation. Intraprocedural AF shown in images C and D presents 2-ms electrogram segments for the highest-frequency region in the inferior interatrial septum (left panel) and the site at which activation originates (right panel; indicated by the circle in image C). Abbreviations as in Figure 1. HeartRhythm Case Reports 2015 1, 22-26DOI: (10.1016/j.hrcr.2014.10.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 Activation time maps rendered on the anterior left atrial wall immediately before linear ablation (A) and after figure 7 lesions (B). These maps show typical reentrant activation patterns that originate adjacent to high-frequency regions. Note that Figures 3A and 3B correspond to Figures 2A and 2B, respectively. Abbreviations as in Figure 1. HeartRhythm Case Reports 2015 1, 22-26DOI: (10.1016/j.hrcr.2014.10.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions