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Mechanisms of Fractionated Electrograms Formation in the Posterior Left Atrium During Paroxysmal Atrial Fibrillation in Humans

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Mechanisms of Fractionated Electrograms Formation in the Posterior Left Atrium During Paroxysmal Atrial Fibrillation in Humans

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dc.contributor.author Atienza, Felipe es_ES
dc.contributor.author Calvo, David es_ES
dc.contributor.author Almendral, Jesús es_ES
dc.contributor.author Zlochiver, Sharon es_ES
dc.contributor.author Grzeda, Krzysztof R. es_ES
dc.contributor.author Martínez Alzamora, María Nieves es_ES
dc.contributor.author González-Torrecilla, Esteban es_ES
dc.contributor.author Arenal, Ángel es_ES
dc.contributor.author Fernández-Avilés, Francisco es_ES
dc.contributor.author Berenfeld, Omer es_ES
dc.date.accessioned 2017-07-31T13:53:19Z
dc.date.available 2017-07-31T13:53:19Z
dc.date.issued 2011-03-01
dc.identifier.issn 0735-1097
dc.identifier.uri http://hdl.handle.net/10251/86008
dc.description.abstract Objectives: The aim of this paper was to study mechanisms of formation of fractionated electrograms on the posterior left atrial wall (PLAW) in human paroxysmal atrial fibrillation (AF). Background: The mechanisms responsible for complex fractionated atrial electrogram formation during AF are poorly understood. Methods: In 24 patients, we induced sustained AF by pacing from a pulmonary vein. We analyzed transitions between organized patterns and changes in electrogram morphology leading to fractionation in relation to interbeat interval duration (systolic interval [SI]) and dominant frequency. Computer simulations of rotors helped in the interpretation of the results. Results: Organized patterns were recorded 31 ± 18% of the time. In 47% of organized patterns, the electrograms and PLAW activation sequence were similar to those of incoming waves during pulmonary vein stimulation that induced AF. Transitions to fractionation were preceded by significant increases in electrogram duration, spike number, and SI shortening (R 2 = 0.94). Similarly, adenosine infusion during organized patterns caused significant SI shortening leading to fractionated electrograms formation. Activation maps during organization showed incoming wave patterns, with earliest activation located closest to the highest dominant frequency site. Activation maps during transitions to fragmentation showed areas of slowed conduction and unidirectional block. Simulations predicted that SI abbreviation that heralds fractionated electrograms formation might result from a Doppler effect on wave fronts preceding an approaching rotor or by acceleration of a stationary or meandering, remotely located source. Conclusions: During induced AF, SI shortening after either drift or acceleration of a source results in intermittent fibrillatory conduction and formation of fractionated electrograms at the PLAW es_ES
dc.description.sponsorship This work was supported in part by grants from the Spanish Society of Cardiology (to Dr. Calvo); National Heart, Lung, and Blood Institute Grants P01-HL039707, P01-HL87226, and R01-HL060843 (to Dr. Berenfeld); and the Ministerio de Ciencia e Innovacion, Red RECAVA (to Drs. Atienza, Gonzalez-Torrecilla, Arenal, and Fernandez-Aviles) and the Centro Nacional de Investigaciones Cardiovasculares (proyecto CNIC-13) (to Drs. Atienza, Almendral, Gonzalez-Torrecilla, and Berenfeld). Dr. Atienza has served on the advisory board of and received lecture fees from Medtronic; and has received research funding from St. Jude Medical Spain. Dr. Berenfeld has received a research grant from St. Jude Medical. All other authors have reported that they have no relationships to disclose. Drs. Atienza and Calvo contributed equally to this work. en_EN
dc.language Inglés es_ES
dc.publisher Elsevier es_ES
dc.relation.ispartof Journal of the American College of Cardiology es_ES
dc.rights Reserva de todos los derechos es_ES
dc.subject Adenosine es_ES
dc.subject Atrial fibrillation es_ES
dc.subject Conduction delay es_ES
dc.subject Fractionated electrograms es_ES
dc.subject Re-entry es_ES
dc.subject.classification ESTADISTICA E INVESTIGACION OPERATIVA es_ES
dc.title Mechanisms of Fractionated Electrograms Formation in the Posterior Left Atrium During Paroxysmal Atrial Fibrillation in Humans es_ES
dc.type Artículo es_ES
dc.identifier.doi 10.1016/j.jacc.2010.09.066
dc.relation.projectID info:eu-repo/grantAgreement/NIH//P01HL039707/ es_ES
dc.relation.projectID info:eu-repo/grantAgreement/NIH//R01HL060843/ es_ES
dc.relation.projectID info:eu-repo/grantAgreement/NIH//P01HL087226-02/ es_ES
dc.relation.projectID info:eu-repo/grantAgreement/MSC//RD06%2F0014/ es_ES
dc.relation.projectID info:eu-repo/grantAgreement/CNIC//CNIC-13/ es_ES
dc.rights.accessRights Cerrado es_ES
dc.contributor.affiliation Universitat Politècnica de València. Departamento de Estadística e Investigación Operativa Aplicadas y Calidad - Departament d'Estadística i Investigació Operativa Aplicades i Qualitat es_ES
dc.description.bibliographicCitation Atienza, F.; Calvo, D.; Almendral, J.; Zlochiver, S.; Grzeda, KR.; Martínez Alzamora, MN.; González-Torrecilla, E.... (2011). Mechanisms of Fractionated Electrograms Formation in the Posterior Left Atrium During Paroxysmal Atrial Fibrillation in Humans. Journal of the American College of Cardiology. 57(9):1081-1092. https://doi.org/10.1016/j.jacc.2010.09.066 es_ES
dc.description.accrualMethod S es_ES
dc.relation.publisherversion http://dx.doi.org/10.1016/j.jacc.2010.09.066 es_ES
dc.description.upvformatpinicio 1081 es_ES
dc.description.upvformatpfin 1092 es_ES
dc.type.version info:eu-repo/semantics/publishedVersion es_ES
dc.description.volume 57 es_ES
dc.description.issue 9 es_ES
dc.relation.senia 40708 es_ES
dc.identifier.pmid 21349400 es_ES
dc.identifier.pmcid PMC3124959 es_ES
dc.contributor.funder Ministerio de Sanidad y Consumo es_ES
dc.contributor.funder National Institutes of Health, EEUU es_ES
dc.contributor.funder Centro Nacional de Investigaciones Cardiovasculares es_ES
dc.contributor.funder Sociedad Española de Cardiología es_ES
dc.contributor.funder St. Jude Medical es_ES


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