Abstract 11913: Stationary Rotational Reentry Identified in Patients with Atrial Fibrillation by Non-contact Mapping: Mechanism and its Substrate
Background: Little is known about the rotational reentry observed in patients with atrial fibrillation (AF). Objectives: The purpose of this study was to define the mechanism and its substrate of the stationary rotational reentry observed in patients with AF. We further elucidated its role for the maintenance mechanism of AF.
Methods: Among 87 patients with AF (73 paroxysmal AF and 14 persistent AF) who underwent three-dimensional non-contact mapping of the left atrium using EnSite 3000, we examined the prevalence of stationary rotational reentry during AF and elucidated its mechanism, especially in relation to the complex fractionated atrial electrogram (CFAE) region. The CFAE was defined with the electrogram interval <120 msec.
Results: Stationary rotational reentry was observed in 11 patients (10 patients with paroxysmal AF and 1 patient with persistent AF; mean age 58±11 years) during mapping before the ablation procedure. The mean tachycardia cycle length was 160.0±19.8 msec. Stationary rotational reentry was observed circulating around the line of block which was formed at the roof in 5 patients, septum in 3 patients and the ostium of the pulmonary vein in 3 patients. Five stationary rotational reentries circulated in a clockwise direction and 6 in a counter-clockwise direction in the supero-inferior view of the left atrium. The length of the line of block observed in the center of the reentry was 15.2±6.9 mm. All line of block was observed in the CFAE region which was identified during AF. During sinus rhythm, there was no scar or conduction block in the area of line of block. The mean amplitude of the atrial electrogram at the line of block region during sinus rhythm was 1.2±0.9 mV, suggesting the functional nature of the line of block observed during stationary rotational reentry.
Conclusions:Stationary rotational reentry can be organized associated with the functional line of block, which was generated in the CFAE region. These suggest that heterogeneous anisotropic property in the CFAE region provide the substrate of stationary rotational reentry and thus contribute to the maintenance of AF.
- © 2012 by American Heart Association, Inc.