Figure 1.
Electrical and Anatomic Mapping of Human Atria.
A. Basket catheter splines are represented as colored lines registered within the right (blue) and left (grey) atria in left anterior oblique and B. right anterior oblique projections. The figure shows alternate splines with positions D (distal) to 4 representing electrodes 1 to 8. C. Bi-atrial schematic showing right atrium as if opened at its poles and left atrium as if opened at its equator, with electrode positions (black dots). D. ECG leads I, aVF and V1 and electrograms of one sinus rhythm beat (red box) captured by baskets in right and left atrium. E. Maps of sinus rhythm activation (isochrones) from high right atrium (sinus node) to low lateral left atrium created from bi-atrial basket recordings.
Figure 2.
Stable Localized sources underlie human atrial fibrillation.
A. Isochrones show an LA rotor in paroxysmal AF, with electrograms during AF (ECG lead I and CS electrodes; scale bar 1 second). Activation times are color-coded (black indicates non-activated, diastole). B. Spatially constrained migration locus of the rotational center, computed every 25–45 ms and joined using third-order Bézier curve fitting. C. Isochrones 90 minutes later, indicating temporal conservation of the rotor. D. Isochrones of a RA rotor in persistent AF. E. Migration locus. F. Isochrones 1 hour later. G. LA repetitive focal beat in paroxysmal AF. H. Conservation of focal beat 1 hour later. In each case, ablation only at the source locus terminated AF within <5 minutes. Scale bar 1 cm.
Figure 3.
AF termination by ablation of Stable LA rotor.
A. Left atrial rotor during paroxysmal AF visualized using isochrones. B. Migration locus of the rotational center, color-coded over time. C. Ablation lesions at rotor in low left atrium, applied 1 hour after initial recording of the rotor, shown on patient specific geometry. Red lesion is where AF terminated, and 3 other lesions (gray) were also applied. D. Electrode recordings during AF with termination to sinus rhythm by <1 minute ablation at the rotational center (ECG lead aVF, and electrodes at ablation catheter, coronary sinus). E. Isochronal map of sinus rhythm. The patient remains free of AF on implanted cardiac monitor at 9 months. Scale Bar 1 cm.
Figure 4.
AF Termination by ablation of a Stable RA Rotor.
A. Isochrones show a RA rotor and concurrent LA focal beat during persistent AF. B. Spatially constrained rotational center locus. C. Ablation lesions at lateral RA rotor on patient specific geometry (performed 2 hours after initial recording of rotor). A total of 11 lesions were applied (shown), with AF termination to sinus rhythm at 5.5 minutes. The red lesion indicates where ablation terminated AF. D. Electrograms AF terminating to sinus rhythm with localized ablation at rotor (total duration 5.5 minutes) (ECG lead I, intracardiac electrodes in RA, LA and CS). E. Isochrones of sinus rhythm. After ablation, the patient remains AF-free at 12 months on implanted cardiac monitor. Scale bar 1 cm.