Evidence map›Paper›PMID 31352796›Full record

ArticleCirculation. Arrhythmia and electrophysiology2019

Wavefront Field Mapping Reveals a Physiologic Network Between Drivers Where Ablation Terminates Atrial Fibrillation.

George Leef, Fatemah Shenasa, Neal K Bhatia, Albert J Rogers, William Sauer, John M Miller, Mark Swerdlow, Mallika Tamboli, Mahmood I Alhusseini, Erin Armenia and 7 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation. Arrhythmia and electrophysiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Persistent atrial fibrillation ablation: glimpsing the light ahead?Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025
    Review
  2. Article
  3. An atrial fibrillation rotor, mapped conventionally.Journal of cardiovascular electrophysiology · 2020
    Article
  4. Review
  5. Review
  6. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors.

George LeefDepartment of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.).
Fatemah ShenasaDepartment of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.).
Neal K BhatiaDepartment of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.).
Albert J RogersDepartment of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.).
William SauerDepartment of Medicine, University of Colorado, Denver (W.S., E.A.).
John M MillerDepartment of Medicine, University of Indiana, Indianapolis (J.M.M.).
Mark SwerdlowDepartment of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.).
Mallika TamboliDepartment of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.).
Mahmood I AlhusseiniDepartment of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.).
Erin ArmeniaDepartment of Medicine, University of Colorado, Denver (W.S., E.A.).
Tina BaykanerDepartment of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.).
Johannes BrachmannDepartment of Cardiology, Klinikum Coburg, Germany (J.B.).
Mintu P TurakhiaDepartment of Medicine, Veterans Affairs Palo Alto Health Care System, CA (M.P.T.).
Felipe AtienzaDepartamento de Cardiologia, Hospital General Universitario Gregorio Maranon, Madrid, Spain (F.A.).
Wouter-Jan RappelDepartment of Physics, University of California, San Diego (W.J.R.).
Paul J WangDepartment of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.).
Sanjiv M NarayanDepartment of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.).

Funding

The Dynamics of Human Atrial FibrillationR01HL083359 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Sanjiv M Narayan · 2008 to 2026
$7.9M
Patient-Directed Computational Analysis of Atrial FibrillationR01HL122384 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI WOUTER-JAN RAPPEL · 2015 to 2026
$5.3M
The Maintenance of Human Atrial FibrillationK24HL103800 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI NARAYAN, SANJIV M · 2010 to 2019
$1.9M
Deep Neural Networks To Treat Atrial FibrillationK23HL145017 · NHLBI · STANFORD UNIVERSITY · PI BAYKANER, TINA · 2019 to 2023
$968k
Determining strength and temporal stability of rotational and focal sources during human atrial fibrillationR21HL145500 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI RAPPEL, WOUTER-JAN · 2019 to 2020
$236k
Novel Atrial Fibrillation Phenotypes Defined by Functional-Anatomical, Machine-Learned ClassificationsF32HL144101 · NHLBI · STANFORD UNIVERSITY · PI ROGERS, ALBERT JOSEPH · 2018 to 2019
$130k
NHLBI NIH HHS F32 HL144101NHLBI NIH HHS K23 HL145017NHLBI NIH HHS K24 HL103800NHLBI NIH HHS R01 HL083359NHLBI NIH HHS R01 HL122384NHLBI NIH HHS R21 HL145500
6 · The paper itself

Abstract

backgroundLocalized drivers are proposed mechanisms for persistent atrial fibrillation (AF) from optical mapping of human atria and clinical studies of AF, yet are controversial because drivers fluctuate and ablating them may not terminate AF. We used wavefront field mapping to test the hypothesis that AF drivers, if concurrent, may interact to produce fluctuating areas of control to explain their appearance/disappearance and acute impact of ablation.

methodsWe recruited 54 patients from an international registry in whom persistent AF terminated by targeted ablation. Unipolar AF electrograms were analyzed from 64-pole baskets to reconstruct activation times, map propagation vectors each 20 ms, and create nonproprietary phase maps.

resultsEach patient (63.6±8.5 years, 29.6% women) showed 4.0±2.1 spatially anchored rotational or focal sites in AF in 3 patterns. First, a single (type I; n=7) or, second, paired chiral-antichiral (type II; n=5) rotational drivers controlled most of the atrial area. Ablation of 1 to 2 large drivers terminated all cases of types I or II AF. Third, interaction of 3 to 5 drivers (type III; n=42) with changing areas of control. Targeted ablation at driver centers terminated AF and required more ablation in types III versus I (P=0.02 in left atrium).

conclusionsWavefront field mapping of persistent AF reveals a pathophysiologic network of a small number of spatially anchored rotational and focal sites, which interact, fluctuate, and control varying areas. Future work should define whether AF drivers that control larger atrial areas are attractive targets for ablation.

Indexed as

AgedAtrial FibrillationBody Surface Potential MappingCatheter AblationFemaleHeart AtriaHeart Conduction SystemHeart RateHumansMaleMiddle Agedatrial fibrillationorganizationspulmonary veinsrecurrenceregistries

Identifiers

PMID31352796
PMCPMC6666420

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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.