{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:43:51Z","timestamp":1787240631960,"version":"build-2736575974"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T00:00:00Z","timestamp":1591228800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T00:00:00Z","timestamp":1591228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Identification of atrial sites that perpetuate atrial fibrillation (AF), and ablation thereof terminates AF, is challenging. We hypothesized that specific electrogram (EGM) characteristics identify AF-termination sites (AFTS). Twenty-one patients in whom low-voltage-guided ablation after pulmonary vein isolation terminated clinical persistent AF were included. Patients were included if short RF-delivery for &lt;8sec at a given atrial site was associated with acute termination of clinical persistent AF.\u00a0EGM-characteristics at 21 AFTS, 105 targeted sites without termination and 105 non-targeted control sites were analyzed. Alteration of EGM-characteristics by local fibrosis was evaluated in a three-dimensional high resolution (100\u2009\u00b5m)-computational AF\u00a0model. AFTS demonstrated lower EGM-voltage, higher EGM-cycle-length-coverage, shorter AF-cycle-length and higher pattern consistency than control sites (0.49\u2009\u00b1\u20090.39\u2009mV vs. 0.83\u2009\u00b1\u20090.76\u2009mV, p\u2009&lt;\u20090.0001; 79\u2009\u00b1\u200916% vs. 59\u2009\u00b1\u200922%, p\u2009=\u20090.0022; 173\u2009\u00b1\u200949\u2009ms vs. 198\u2009\u00b1\u200934\u2009ms, p\u2009=\u20090.047; 80% vs. 30%, p\u2009&lt;\u20090.01). Among targeted sites, AFTS had higher EGM-cycle-length coverage, shorter local AF-cycle-length and higher pattern consistency than targeted sites without AF-termination (79\u2009\u00b1\u200916% vs. 63\u2009\u00b1\u200923%, p\u2009=\u20090.02; 173\u2009\u00b1\u200949\u2009ms vs. 210\u2009\u00b1\u200944\u2009ms, p\u2009=\u20090.002; 80% vs. 40%, p\u2009=\u20090.01). Low voltage (0.52\u2009\u00b1\u20090.3\u2009mV) fractionated EGMs (79\u2009\u00b1\u200924\u2009ms) with delayed components\u00a0in sinus rhythm (\u2018atrial late potentials\u2019, respectively \u2018ALP\u2019) were observed at 71% of AFTS. EGMs recorded from fibrotic areas in computational models demonstrated comparable EGM-characteristics both in simulated AF and sinus rhythm. AFTS may therefore be identified by locally consistent, fractionated low-voltage EGMs with high cycle-length-coverage and rapid activity in AF, with low-voltage, fractionated\u00a0EGMs with\u00a0delayed components\/ \u2018atrial late potentials\u2019 (ALP)\u00a0persisting in sinus rhythm.<\/jats:p>","DOI":"10.1038\/s41598-020-65564-2","type":"journal-article","created":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T06:03:02Z","timestamp":1591250582000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Specific Electrogram Characteristics Identify the Extra-Pulmonary Vein Arrhythmogenic Sources of\u00a0Persistent Atrial Fibrillation \u2013 Characterization of the Arrhythmogenic Electrogram Patterns During Atrial Fibrillation and Sinus Rhythm"],"prefix":"10.1038","volume":"10","author":[{"given":"Amir","family":"Jadidi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Nothstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heiko","family":"Lehrmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olaf","family":"D\u00f6ssel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Allgeier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietmar","family":"Trenk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz-Josef","family":"Neumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Loewe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"M\u00fcller-Edenborn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Arentz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,6,4]]},"reference":[{"issue":"10","key":"65564_CR1","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1056\/NEJM199809033391003","volume":"339","author":"Michel Ha\u00efssaguerre","year":"1998","unstructured":"Ha\u00efssaguerre, M. et al. Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary Veins, N. Engl. J. Med., vol. 339, no. 10, pp. 659\u2013666, (Sep. 1998).","journal-title":"New England Journal of Medicine"},{"issue":"6","key":"65564_CR2","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1161\/CIRCULATIONAHA.104.517011","volume":"112","author":"Prashanthan Sanders","year":"2005","unstructured":"Sanders, P. et al. Spectral Analysis Identifies Sites of High-Frequency Activity Maintaining Atrial Fibrillation in Humans, Circulation, vol. 112, no. 6, pp. 789\u2013797, (Aug. 2005).","journal-title":"Circulation"},{"issue":"no. 3","key":"65564_CR3","doi-asserted-by":"publisher","first-page":"e002962","DOI":"10.1161\/CIRCEP.115.002962","volume":"9","author":"AS Jadidi","year":"2016","unstructured":"Jadidi, A. S. et al. Ablation of Persistent Atrial Fibrillation Targeting Low-Voltage Areas With Selective Activation Characteristics. Circ. Arrhythmia Electrophysiol. 9(no. 3), e002962 (2016).","journal-title":"Circ. Arrhythmia Electrophysiol."},{"issue":"no. 3","key":"65564_CR4","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.jacc.2016.10.065","volume":"69","author":"J Seitz","year":"2017","unstructured":"Seitz, J. et al. AF Ablation Guided by Spatiotemporal Electrogram Dispersion Without Pulmonary Vein Isolation: A Wholly Patient-Tailored Approach. J. Am. Coll. Cardiol. 69(no. 3), 303\u2013321 (2017).","journal-title":"J. Am. Coll. Cardiol."},{"issue":"no. 1","key":"65564_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-019-48669-1","volume":"9","author":"S Kawai","year":"2019","unstructured":"Kawai, S. et al. Non-Pulmonary Vein Triggers of Atrial Fibrillation Are Likely to Arise from Low-Voltage Areas in the Left Atrium. Sci. Rep. 9(no. 1), 1\u201311 (2019).","journal-title":"Sci. Rep."},{"issue":"no. 19","key":"65564_CR6","doi-asserted-by":"publisher","first-page":"1812","DOI":"10.1056\/NEJMoa1408288","volume":"372","author":"A Verma","year":"2015","unstructured":"Verma, A. et al. Approaches to catheter ablation for persistent atrial fibrillation. N. Engl. J. Med. 372(no. 19), 1812\u201322 (2015).","journal-title":"N. Engl. J. Med."},{"issue":"11","key":"65564_CR7","doi-asserted-by":"publisher","first-page":"1344","DOI":"10.1093\/eurheartj\/ehq041","volume":"31","author":"A. Verma","year":"2010","unstructured":"A. Verma et al. Substrate and Trigger Ablation for Reduction of Atrial Fibrillation (STAR AF): a randomized, multicentre, international trial, Eur. Heart J., vol. 31, no. 11, pp. 1344\u20131356, (Jun. 2010).","journal-title":"European Heart Journal"},{"issue":"no. 3","key":"65564_CR8","doi-asserted-by":"publisher","first-page":"e002962","DOI":"10.1161\/CIRCEP.115.002962","volume":"9","author":"AS Jadidi","year":"2016","unstructured":"Jadidi, A. S. et al. Ablation of Persistent Atrial Fibrillation Targeting Low-Voltage Areas With Selective Activation Characteristics. Circ. Arrhythmia Electrophysiol. 9(no. 3), e002962 (2016).","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"65564_CR9","doi-asserted-by":"crossref","unstructured":"Courtemanche, M., Ramirez, R. J. & Nattel, S. Ionic mechanisms underlying human atrial action potential properties: insights from a mathematical model, Am. J. Physiol. Circ. Physiol., vol. 275, no. 1, pp. H301\u2013H321, (Jul. 1998).","DOI":"10.1152\/ajpheart.1998.275.1.H301"},{"key":"65564_CR10","first-page":"929","volume":"59","author":"A Loewe","year":"2014","unstructured":"Loewe, A., Wilhelms, M., D\u00f6ssel, O. & Seemann, G. Influence of chronic atrial fibrillation induced remodeling in a computational electrophysiological model. Biomed. Tech. 59, 929\u2013932 (2014).","journal-title":"Biomed. Tech."},{"key":"65564_CR11","doi-asserted-by":"crossref","unstructured":"Spach, M. S., Heidlage, J. F., Dolber, P. C. & Barr, R. C. Mechanism of origin of conduction disturbances in aging human atrial bundles: Experimental and model study, Hear. Rhythm, vol. 4, no. 2, pp. 175\u2013185, (Feb. 2007).","DOI":"10.1016\/j.hrthm.2006.10.023"},{"key":"65564_CR12","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1007\/978-3-642-12110-4_55","volume-title":"Progress in Industrial Mathematics at ECMI 2008","author":"G. Seemann","year":"2010","unstructured":"Seemann, G. et al. Framework for Modular, Flexible and Efficient Solving the Cardiac Bidomain Equations Using PETSc, pp. 363\u2013369 (Springer, Berlin, Heidelberg, 2010)."},{"key":"65564_CR13","doi-asserted-by":"publisher","first-page":"2044","DOI":"10.1016\/j.jacc.2003.12.054","volume":"43","author":"K Nademanee","year":"2004","unstructured":"Nademanee, K. et al. A new approach for catheter ablation of atrial fibrillation: Mapping of the electrophysiologic substrate. J. Am. Coll. Cardiol. 43, 2044\u20132053 (2004).","journal-title":"J. Am. Coll. Cardiol."},{"issue":"no. 5","key":"65564_CR14","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1161\/CIRCULATIONAHA.105.546648","volume":"113","author":"M Ha\u00efssaguerre","year":"2006","unstructured":"Ha\u00efssaguerre, M. et al. Localized sources maintaining atrial fibrillation organized by prior ablation. Circulation 113(no. 5), 616\u2013625 (2006).","journal-title":"Circulation"},{"issue":"no. 5","key":"65564_CR15","first-page":"825","volume":"7","author":"S Rolf","year":"2014","unstructured":"Rolf, S. et al. Tailored atrial substrate modification based on low-voltage areas in catheter ablation of atrial fibrillation. Circulation: Arrhythmia and Electrophysiology 7(no. 5), 825\u2013833 (2014).","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"issue":"no. 2","key":"65564_CR16","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1111\/jce.13122","volume":"28","author":"A Yagishita","year":"2017","unstructured":"Yagishita, A. et al. Long-Term Outcome of Left Atrial Voltage-Guided Substrate Ablation During Atrial Fibrillation: A Novel Adjunctive Ablation Strategy. J. Cardiovasc. Electrophysiol. 28(no. 2), 147\u2013155 (2017).","journal-title":"J. Cardiovasc. Electrophysiol."},{"issue":"no. 9","key":"65564_CR17","doi-asserted-by":"publisher","first-page":"2387","DOI":"10.1113\/JP270617","volume":"594","author":"M Haissaguerre","year":"2016","unstructured":"Haissaguerre, M. et al. Intermittent drivers anchoring to structural heterogeneities as a major pathophysiological mechanism of human persistent atrial fibrillation. J. Physiol. 594(no. 9), 2387\u20132398 (2016).","journal-title":"J. Physiol."},{"issue":"no. 3","key":"65564_CR18","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1093\/cvr\/cvw073","volume":"110","author":"S Zahid","year":"2016","unstructured":"Zahid, S. et al. Patient-derived models link re-entrant driver localization in atrial fibrillation to fibrosis spatial pattern. Cardiovasc. Res. 110(no. 3), 443\u2013454 (2016).","journal-title":"Cardiovasc. Res."},{"key":"65564_CR19","doi-asserted-by":"crossref","unstructured":"Boyle, P. M., Zahid, S. & Trayanova, N. A. Towards personalized computational modelling of the fibrotic substrate for atrial arrhythmia, EP Eur., vol. 18, no. suppl_4, pp. iv136\u2013iv145, (Dec. 2016).","DOI":"10.1093\/europace\/euw358"},{"issue":"12","key":"65564_CR20","doi-asserted-by":"publisher","first-page":"2764","DOI":"10.1016\/j.bpj.2013.05.025","volume":"104","author":"Kathleen\u00a0S. McDowell","year":"2013","unstructured":"McDowell, K. S. et al. Mechanistic Inquiry into the Role of Tissue Remodeling in Fibrotic Lesions in Human Atrial Fibrillation, Biophys. J., vol. 104, no. 12, pp. 2764\u20132773, (Jun. 2013).","journal-title":"Biophysical Journal"},{"key":"65564_CR21","doi-asserted-by":"crossref","unstructured":"Alonso, S. & B\u00e4r, M. Reentry Near the Percolation Threshold in a Heterogeneous Discrete Model for Cardiac Tissue, Phys. Rev. Lett., vol. 110, no. 15, p. 158101, (Apr. 2013).","DOI":"10.1103\/PhysRevLett.110.158101"},{"key":"65564_CR22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2016\/5340574","volume":"2016","author":"Tobias Oesterlein","year":"2016","unstructured":"Oesterlein, T. et al. Basket-Type Catheters: Diagnostic Pitfalls Caused by Deformation and Limited Coverage, Biomed Res. Int., vol. 2016, pp. 1\u201313, (Dec. 2016).","journal-title":"BioMed Research International"},{"issue":"no. 12","key":"65564_CR23","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1016\/j.jacep.2018.08.015","volume":"4","author":"M Rodr\u00edguez-Ma\u00f1ero","year":"2018","unstructured":"Rodr\u00edguez-Ma\u00f1ero, M. et al. Validating Left Atrial Low Voltage Areas During Atrial Fibrillation and Atrial Flutter Using Multielectrode Automated Electroanatomic Mapping. JACC Clin. Electrophysiol. 4(no. 12), 1541\u20131552 (2018).","journal-title":"JACC Clin. Electrophysiol."},{"key":"65564_CR24","doi-asserted-by":"publisher","first-page":"no. 2","DOI":"10.1161\/CIRCEP.115.003382","volume":"9","author":"G Yang","year":"2016","unstructured":"Yang, G. et al. Catheter Ablation of Nonparoxysmal Atrial Fibrillation Using Electrophysiologically Guided Substrate Modification during Sinus Rhythm after Pulmonary Vein Isolation. Circ. Arrhythmia Electrophysiol. 9, no. 2 (2016).","journal-title":"Circ. Arrhythmia Electrophysiol."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-65564-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-65564-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-65564-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T06:37:38Z","timestamp":1670308658000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-65564-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,4]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["65564"],"URL":"https:\/\/doi.org\/10.1038\/s41598-020-65564-2","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,4]]},"assertion":[{"value":"31 October 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 April 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"9147"}}