Evidence map›Paper›PMID 29884620›Full record

ArticleCirculation. Arrhythmia and electrophysiology2018

Interaction of Localized Drivers and Disorganized Activation in Persistent Atrial Fibrillation: Reconciling Putative Mechanisms Using Multiple Mapping Techniques.

Christopher A B Kowalewski, Fatemah Shenasa, Miguel Rodrigo, Paul Clopton, Gabriela Meckler, Mahmood I Alhusseini, Mark A Swerdlow, Vijay Joshi, Samir Hossainy, Junaid A B Zaman and 9 more

Registry-linked trialOpen access · bronzeAbstract readMulticenter StudyVideo-Audio Media
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation. Arrhythmia and electrophysiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02997254 (COMparison of Physiological Algorithms for Real-time Evaluation of Atrial Fibrillation), which is not on this map. Cited by 30 papers.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed
4.1field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02997254 recruitingnot on this map

COMparison of Physiological Algorithms for Real-time Evaluation of Atrial Fibrillation

TypeobservationalSponsorStanford UniversityRan2016 to 2027Enrolled1,000ConditionsAtrial Fibrillation, Abnormal Heart Rhythms
3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 33 citations in OpenAlex.

  1. Trial
  2. Review
  3. Epicardial muscle bundles in persistent atrial fibrillation: from overlooked bystanders to arrhythmogenic modulators.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
    Review
  4. Article
  5. Article
  6. Spatially Conserved Spiral Wave Activity During Human Atrial Fibrillation.Circulation. Arrhythmia and electrophysiology · 2024
    Article
  7. Future Directions for Mapping Atrial Fibrillation.Arrhythmia & electrophysiology review · 2022
    Review
  8. Article
  9. Article
  10. Review
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors at 7 institutions in 3 countries.

Christopher A B KowalewskiDepartment of Medicine, Stanford University, CA (C.A.B.K., F.S., M.R., P.C., G.M., M.I.A., M.A.S., V.J., J.A.B.Z., T.B., A.J.R., P.J.W., S.M.N.).
Fatemah ShenasaDepartment of Medicine, Stanford University, CA (C.A.B.K., F.S., M.R., P.C., G.M., M.I.A., M.A.S., V.J., J.A.B.Z., T.B., A.J.R., P.J.W., S.M.N.).
Miguel RodrigoDepartment of Medicine, Stanford University, CA (C.A.B.K., F.S., M.R., P.C., G.M., M.I.A., M.A.S., V.J., J.A.B.Z., T.B., A.J.R., P.J.W., S.M.N.).
Paul CloptonDepartment of Medicine, Stanford University, CA (C.A.B.K., F.S., M.R., P.C., G.M., M.I.A., M.A.S., V.J., J.A.B.Z., T.B., A.J.R., P.J.W., S.M.N.).
Gabriela MecklerDepartment of Medicine, Stanford University, CA (C.A.B.K., F.S., M.R., P.C., G.M., M.I.A., M.A.S., V.J., J.A.B.Z., T.B., A.J.R., P.J.W., S.M.N.).
Mahmood I AlhusseiniDepartment of Medicine, Stanford University, CA (C.A.B.K., F.S., M.R., P.C., G.M., M.I.A., M.A.S., V.J., J.A.B.Z., T.B., A.J.R., P.J.W., S.M.N.).
Mark A SwerdlowDepartment of Medicine, Stanford University, CA (C.A.B.K., F.S., M.R., P.C., G.M., M.I.A., M.A.S., V.J., J.A.B.Z., T.B., A.J.R., P.J.W., S.M.N.).
Vijay JoshiDepartment of Medicine, Stanford University, CA (C.A.B.K., F.S., M.R., P.C., G.M., M.I.A., M.A.S., V.J., J.A.B.Z., T.B., A.J.R., P.J.W., S.M.N.).
Samir HossainyDepartment of Engineering, University of California, Berkeley (S.H.).
Junaid A B ZamanDepartment of Medicine, Stanford University, CA (C.A.B.K., F.S., M.R., P.C., G.M., M.I.A., M.A.S., V.J., J.A.B.Z., T.B., A.J.R., P.J.W., S.M.N.).
Tina BaykanerDepartment of Medicine, Stanford University, CA (C.A.B.K., F.S., M.R., P.C., G.M., M.I.A., M.A.S., V.J., J.A.B.Z., T.B., A.J.R., P.J.W., S.M.N.).
Albert J RogersDepartment of Medicine, Stanford University, CA (C.A.B.K., F.S., M.R., P.C., G.M., M.I.A., M.A.S., V.J., J.A.B.Z., T.B., A.J.R., P.J.W., S.M.N.).
Johannes BrachmannKlinikum Coburg, Germany (J.B.).
John M MillerDepartment of Medicine, Indiana University, Indianapolis (J.M.M.).
David E KrummenDepartment of Medicine, University of California San Diego (D.E.K.).
William H SauerDepartment of Medicine, University of Colorado, Denver (W.H.S.).
Nicholas S PetersElectroCardioMaths Programme, Imperial College, London, United Kingdom (J.A.B.Z., N.S.P.).
Paul J WangDepartment of Medicine, Stanford University, CA (C.A.B.K., F.S., M.R., P.C., G.M., M.I.A., M.A.S., V.J., J.A.B.Z., T.B., A.J.R., P.J.W., S.M.N.).
Sanjiv M NarayanDepartment of Medicine, Stanford University, CA (C.A.B.K., F.S., M.R., P.C., G.M., M.I.A., M.A.S., V.J., J.A.B.Z., T.B., A.J.R., P.J.W., S.M.N.). sanjiv1@stanford.edu.
MACOM (United States) · USIndiana University – Purdue University Indianapolis · USKlinikum Coburg · DESt Nicholas Hospital · GBUniversity of California, Berkeley · USUniversity of Denver · USUniversity of San Diego · US

Funding

The Dynamics of Human Atrial FibrillationR01HL083359 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Sanjiv M Narayan · 2008 to 2026
$7.9M
The Maintenance of Human Atrial FibrillationK24HL103800 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI NARAYAN, SANJIV M · 2010 to 2019
$1.9M
Novel Atrial Fibrillation Phenotypes Defined by Functional-Anatomical, Machine-Learned ClassificationsF32HL144101 · NHLBI · STANFORD UNIVERSITY · PI ROGERS, ALBERT JOSEPH · 2018 to 2019
$130k
British Heart Foundation FS/14/46/30907British Heart Foundation RG/16/3/32175Department of HealthNHLBI NIH HHS F32 HL144101NHLBI NIH HHS K24 HL103800NHLBI NIH HHS R01 HL083359
6 · The paper itself

Abstract

backgroundMechanisms for persistent atrial fibrillation (AF) are unclear. We hypothesized that putative AF drivers and disorganized zones may interact dynamically over short time scales. We studied this interaction over prolonged durations, focusing on regions where ablation terminates persistent AF using 2 mapping methods.

methodsWe recruited 55 patients with persistent AF in whom ablation terminated AF prior to pulmonary vein isolation from a multicenter registry. AF was mapped globally using electrograms for 360±45 cycles using (1) a published phase method and (2) a commercial activation/phase method.

resultsPatients were 62.2±9.7 years, 76% male. Sites of AF termination showed rotational/focal patterns by methods 1 and 2 (51/55 vs 55/55;

conclusionsSites at which persistent AF terminated by ablation show organized activation that fluctuate over time, because of collision from concurrent organized zones or fibrillatory waves, yet recur in conserved spatial regions. Results were similar by 2 mapping methods. This network of competing mechanisms should be reconciled with existing disorganized or driver mechanisms for AF, to improve clinical mapping and ablation of persistent AF. CLINICAL

trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT02997254.

Indexed as

Action PotentialsCatheter AblationElectrophysiologic Techniques, CardiacAgedAtrial FibrillationFemaleGermanyHeart Conduction SystemHeart RateHumansMaleMiddle AgedPredictive Value of TestsRegistriesTime FactorsTreatment Outcomeatrial fibrillationmappingnetworkpatientspulmonary veinregistriestachycardia

Identifiers

PMID29884620
PMCPMC6475887
OpenAlexW2805448341

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.