{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:15:54Z","timestamp":1790835354907,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,6,18]],"date-time":"2019-06-18T00:00:00Z","timestamp":1560816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["PG\/13\/37\/30280"],"award-info":[{"award-number":["PG\/13\/37\/30280"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["WT 203148\/Z\/16\/Z"],"award-info":[{"award-number":["WT 203148\/Z\/16\/Z"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The multiple wavelets and functional re\u2010entry hypotheses are mechanistic theories to explain atrial fibrillation (AF). If valid, a chamber's ability to support AF should depend upon the left atrial size, conduction velocity (CV), and refractoriness. Measurement of these parameters could provide a new therapeutic target for AF. We investigated the relationship between left atrial effective conducting size (LA<jats:sub>ECS<\/jats:sub>), a function of area, CV and refractoriness, and AF vulnerability in patients undergoing AF ablation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>Activation mapping was performed in patients with paroxysmal (n\u2009=\u200921) and persistent AF (n\u2009=\u200918) undergoing pulmonary vein isolation. Parameters used for calculating LA<jats:sub>ECS<\/jats:sub> were: (a) left atrial body area (<jats:italic>A<\/jats:italic>); (b) effective refractory period (ERP); and (c) total activation time (<jats:italic>T<\/jats:italic>). Global CV was estimated as <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/jce13990-math-0001.png\" xlink:title=\"urn:x-wiley:10453873:media:jce13990:jce13990-math-0001\"\/>. Effective atrial conducting size was calculated as <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/jce13990-math-0002.png\" xlink:title=\"urn:x-wiley:10453873:media:jce13990:jce13990-math-0002\"\/>. Post ablation, AF inducibility testing was performed. The critical LA<jats:sub>ECS<\/jats:sub> required for multiple wavelet termination was determined from computational modeling. LA<jats:sub>ECS<\/jats:sub> was greater in patients with persistent vs paroxysmal AF (4.4\u2009\u00b1\u20092.0\u2009cm vs 3.2\u2009\u00b1\u20091.4\u2009cm; <jats:italic>P<\/jats:italic>\u2009=\u2009.049). AF was inducible in 14\/39 patients. LA<jats:sub>ECS<\/jats:sub> was greater in AF\u2010inducible patients (4.4\u2009\u00b1\u20091.8\u2009cm vs 3.3\u2009\u00b1\u20091.7\u2009cm; <jats:italic>P<\/jats:italic>\u2009=\u2009.035, respectively). The difference in LA<jats:sub>ECS<\/jats:sub> between inducible and noninducible patients was significant in patients with persistent (<jats:italic>P<\/jats:italic>\u2009=\u2009.0046) but not paroxysmal AF (<jats:italic>P<\/jats:italic>\u2009=\u2009.6359). Computational modeling confirmed that LA<jats:sub>ECS<\/jats:sub>\u2009&gt;\u20094\u2009cm was required for continuation of AF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LA<jats:sub>ECS<\/jats:sub> measured post ablation was associated with AF inducibility in patients with persistent, but not paroxysmal AF. These data support a role for this method in electrical substrate assessment in AF patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.13990","type":"journal-article","created":{"date-parts":[[2019,5,21]],"date-time":"2019-05-21T07:00:51Z","timestamp":1558422051000},"page":"1416-1427","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Left atrial effective conducting size predicts atrial fibrillation vulnerability in persistent but not paroxysmal atrial fibrillation"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7266-2084","authenticated-orcid":false,"given":"Steven E.","family":"Williams","sequence":"first","affiliation":[{"name":"Division of Imaging Sciences and Biomedical Engineering King's College London London United 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Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Metzner","sequence":"additional","affiliation":[{"name":"Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Rei\u00dfmann","sequence":"additional","affiliation":[{"name":"Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul K.","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Division of Imaging Sciences and Biomedical Engineering King's College London London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iain","family":"Sim","sequence":"additional","affiliation":[{"name":"Division of Imaging Sciences and Biomedical Engineering King's College London London United 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