PMID- 30279660
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 1664-042X (Print)
IS  - 1664-042X (Electronic)
IS  - 1664-042X (Linking)
VI  - 9
DP  - 2018
TI  - Targeting the Substrate in Ablation of Persistent Atrial Fibrillation: Recent 
      Lessons and Future Directions.
PG  - 1158
LID - 10.3389/fphys.2018.01158 [doi]
LID - 1158
AB  - While isolation of the pulmonary veins is firmly established as effective 
      treatment for the majority of paroxysmal atrial fibrillation (AF) patients, there 
      is recognition that patients with persistent AF have substrate for perpetuation 
      of arrhythmia existing outside of the pulmonary veins. Various computational 
      approaches have been used to identify targets for effective ablation of 
      persistent AF. This paper aims to discuss the clinical aspects of computational 
      approaches that aim to identify critical sites for treatment. Various analyses of 
      electrogram characteristics have been performed with this aim. Leading techniques 
      for electrogram analysis are Complex Fractionated Atrial Electrograms (CFAE) and 
      Dominant Frequency (DF). These techniques have been the subject of clinical 
      trials of which the results are discussed. Evaluation of the activation patterns 
      of atria in AF has been another avenue of research. Focal Impulse and Rotor 
      Modulation (FIRM) mapping and forms of Body Surface Mapping aim to characterize 
      multiple atrial wavelets, macro-reentry and focal sources which have been 
      proposed as basic mechanisms perpetuating AF. Both invasive and non-invasive 
      activation mapping techniques are reviewed. The presence of atrial fibrosis 
      causes non-uniform anisotropic impulse propagation. Therefore, identification of 
      fibrosis by imaging techniques is an avenue of potential research. The leading 
      contender for imaging-based techniques is Cardiac Magnetic Resonance (CMR). As 
      this technology advances, improvements in resolution and scar identification have 
      positioned CMR as the mode of choice for analysis of atrial structure. AF has 
      been demonstrated to be associated with obesity, inactivity and diseases of 
      modern life. An opportunity exists for detailed computational analysis of the 
      impact of risk factor modification on atrial substrate. This ranges from 
      microstructural investigation through to examination at a population level via 
      registries and public health interventions. Computational analysis of atrial 
      substrate has moved from basic science toward clinical application. Future 
      directions and potential limitations of such analyses are examined in this 
      review.
FAU - Stiles, Martin K
AU  - Stiles MK
AD  - Waikato Clinical School, University of Auckland, Hamilton, New Zealand.
AD  - Department of Cardiology, Waikato District Health Board, Hamilton, New Zealand.
FAU - Sanders, Prashanthan
AU  - Sanders P
AD  - Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical 
      Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide 
      Hospital, Adelaide, SA, Australia.
FAU - Lau, Dennis H
AU  - Lau DH
AD  - Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical 
      Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide 
      Hospital, Adelaide, SA, Australia.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20180918
PL  - Switzerland
TA  - Front Physiol
JT  - Frontiers in physiology
JID - 101549006
PMC - PMC6154526
OTO - NOTNLM
OT  - ablation techniques
OT  - atrial fibrillation
OT  - fibrosis
OT  - imaging
OT  - lifestyle interventions
OT  - mapping & localization
OT  - three-dimensional
EDAT- 2018/10/04 06:00
MHDA- 2018/10/04 06:01
PMCR- 2018/09/18
CRDT- 2018/10/04 06:00
PHST- 2018/04/25 00:00 [received]
PHST- 2018/08/02 00:00 [accepted]
PHST- 2018/10/04 06:00 [entrez]
PHST- 2018/10/04 06:00 [pubmed]
PHST- 2018/10/04 06:01 [medline]
PHST- 2018/09/18 00:00 [pmc-release]
AID - 10.3389/fphys.2018.01158 [doi]
PST - epublish
SO  - Front Physiol. 2018 Sep 18;9:1158. doi: 10.3389/fphys.2018.01158. eCollection 
      2018.