Evidence map›Paper›PMID 32634027›Full record

ArticleCirculation. Arrhythmia and electrophysiology2020

Endocardial-Epicardial Phase Mapping of Prolonged Persistent Atrial Fibrillation Recordings: High Prevalence of Dissociated Activation Patterns.

Ramanathan Parameswaran, Jonathan M Kalman, Alistair Royse, John Goldblatt, Marco Larobina, Troy Watts, Tomos E Walters, Chrishan J Nalliah, Geoffrey Wong, Ahmed Al-Kaisey and 8 more

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Article in Circulation. Arrhythmia and electrophysiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed
3.1field-weighted citation impact, top 7% 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.

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

28 citing papers in PubMed, 37 citations in OpenAlex.

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  11. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.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 · 2024
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  12. Review
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  15. Rotor mechanism and its mapping in atrial fibrillation.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 · 2023
    Review
  16. Article
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  20. Hybrid Ablation of Atrial Fibrillation: A Contemporary Overview.Journal of cardiovascular development and disease · 2022
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors at 6 institutions in 2 countries.

Ramanathan ParameswaranDepartment of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.).
Jonathan M Kalman *Department of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.).
Alistair RoyseDepartment of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.).
John GoldblattDepartment of Cardiothoracic Surgery, Royal Melbourne Hospital (A.R., J.G., M.L.).
Marco LarobinaDepartment of Cardiothoracic Surgery, Royal Melbourne Hospital (A.R., J.G., M.L.).
Troy WattsDepartment of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.).
Tomos E WaltersSection of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco (T.E.W., E.P.G).
Chrishan J NalliahDepartment of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.).
Geoffrey WongDepartment of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.).
Ahmed Al-KaiseyDepartment of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.).
Robert Douglas AndersonDepartment of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.).
Aleksandr VoskoboinikDepartment of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.).
Hariharan SugumarDepartment of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.).
David ChiengDepartment of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.).
Prashanthan SandersCentre for Heart Rhythm Disorders, South Australian Health & Medical Research Institute, University of Adelaide, Royal Adelaide Hospital, Australia (P.S.).
Peter M KistlerDepartment of Medicine, University of Melbourne (R.P., J.M.K., A.R., C.J.N., G.W., A.A.-K., R.D.A., A.V., H.S., D.C., P.M.K., G.L.).
Edward P GerstenfeldSection of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco (T.E.W., E.P.G).
Geoffrey Lee *Department of Cardiology, Royal Melbourne Hospital (R.P., J.M.K., T.W., C.J.N., G.W., A.A.-K., R.D.A., G.L.).
The Royal Melbourne Hospital · AUBaker Heart and Diabetes Institute · AUUniversity of California, San Francisco · USMACOM (United States) · USRoyal Adelaide Hospital · AUThe University of Melbourne · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEndocardial-epicardial dissociation and focal breakthroughs in humans with atrial fibrillation (AF) have been recently demonstrated using activation mapping of short 10-second AF segments. In the current study, we used simultaneous endo-epi phase mapping to characterize endo-epi activation patterns on long segments of human persistent AF.

methodsSimultaneous intraoperative mapping of endo- and epicardial lateral right atrium wall was performed in patients with persistent AF using 2 high-density grid catheters (16 electrodes, 3 mm spacing). Filtered unipolar and bipolar electrograms of continuous 2-minute AF recordings and electrodes locations were exported for phase analyses. We defined endocardial-epicardial dissociation as phase difference of ≥20 ms between paired endo-epi electrodes. Wavefronts were classified as rotations, single wavefronts, focal waves, or disorganized activity as per standard criteria. Endo-Epi wavefront patterns were simultaneously compared on dynamic phase maps. Complex fractionated electrograms were defined as bipolar electrograms with ≥5 directional changes occupying at least 70% of sample duration.

resultsFourteen patients with persistent AF undergoing cardiac surgery were included. Endocardial-epicardial dissociation was seen in 50.3% of phase maps with significant temporal heterogeneity. Disorganized activity (Endo: 41.3% versus Epi: 46.8%,

conclusionsSimultaneous endo-epi phase mapping of prolonged human persistent AF recordings shows significant Endocardial-epicardial dissociation marked temporal heterogeneity, discordant and transitioning wavefronts patterns and complex fractionations. No sustained focal activity was observed. Such complex 3-dimensional interactions provide insight into why endocardial mapping alone may not fully characterize the AF mechanism and why endocardial ablation may not be sufficient. Graphic Abstract: A graphic abstract is available for this article.

Indexed as

Action PotentialsCardiac CatheterizationEpicardial MappingHeart RateAgedAtrial FibrillationCardiac CathetersEndocardiumFemaleHumansMaleMiddle AgedPericardiumPredictive Value of TestsTime Factorsatrial fibrillationatriumendocardial-epicardialfractionationhumanmappingwavefronts

Identifiers

PMID32634027
OpenAlexW3040869793

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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.