{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:05:12Z","timestamp":1791475512509,"version":"4.3.4"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>The mechanisms that initiate and sustain persistent atrial fibrillation are not well characterized. Ablation results remain significantly worse than in paroxysmal atrial fibrillation in which the mechanism is better understood and subsequent targeted therapy has been developed. The aim of this study was to characterize and quantify patterns of activation during atrial fibrillation using contact mapping.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Patients with persistent atrial fibrillation (n=14; mean age, 61\u00b18 years; ejection fraction, 59\u00b110%) underwent simultaneous biatrial contact mapping with 64 electrode catheters. The atrial electrograms were transformed into phase, and subsequent spatiotemporal mapping was performed to identify phase singularities (PSs).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              PSs were located in both atria, but we observed more PSs in the left atrium compared with the right atrium (779\u00b1302, 552\u00b1235;\n              <jats:italic>P<\/jats:italic>\n              =0.015). Although some PSs of duration sufficient to complete &gt;1 rotation were detected, the maximum PS duration was only 1150 ms, and the vast majority (97%) of PSs persisted for too short a period to complete a full rotation. Although in selected patients there was evidence of PS local clustering, overall, PSs were distributed globally throughout both chambers with no clear anatomic predisposition. In a subset of patients (n=7), analysis was repeated using an alternative established atrial PS mapping technique, which confirmed our initial findings.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>No sustained rotors or localized drivers were detected, and instead, the mechanism of arrhythmia maintenance was consistent with the multiple wavelet hypothesis, with passive activation of short-lived rotational activity.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT01765075.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.117.005897","type":"journal-article","created":{"date-parts":[[2018,6,1]],"date-time":"2018-06-01T09:15:17Z","timestamp":1527844517000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Unraveling the Underlying Arrhythmia Mechanism in Persistent Atrial Fibrillation"],"prefix":"10.1161","volume":"11","author":[{"given":"Nicholas","family":"Child","sequence":"first","affiliation":[{"name":"Department of Imaging Sciences and Biomedical Engineering, King\u2019s College London, United Kingdom (N.C., C.H.R., T.J., B.P., S.A.N., R.S.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard H.","family":"Clayton","sequence":"additional","affiliation":[{"name":"INSIGNEO Institute for In Silico Medicine, University of Sheffield, United Kingdom (R.H.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline H.","family":"Roney","sequence":"additional","affiliation":[{"name":"Department of Imaging Sciences and Biomedical Engineering, King\u2019s College London, United Kingdom (N.C., C.H.R., T.J., B.P., S.A.N., R.S.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob I.","family":"Laughner","sequence":"additional","affiliation":[{"name":"Boston Scientific Corp, St. Paul, MN (J.I.L., A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Shuros","sequence":"additional","affiliation":[{"name":"Boston Scientific Corp, St. Paul, MN (J.I.L., A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petr","family":"Neuzil","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Na Holmolce Hospital, Prague, Czech Republic (P.N., J.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Petru","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Na Holmolce Hospital, Prague, Czech Republic (P.N., J.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Imaging Sciences and Biomedical Engineering, King\u2019s College London, United Kingdom (N.C., C.H.R., T.J., B.P., S.A.N., R.S.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Porter","sequence":"additional","affiliation":[{"name":"Department of Imaging Sciences and Biomedical Engineering, King\u2019s College London, United Kingdom (N.C., C.H.R., T.J., B.P., S.A.N., R.S.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Bostock","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Guy\u2019s and St Thomas\u2019 Hospital, London, United Kingdom (J.B., C.A.R., M.J.W., J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven A.","family":"Niederer","sequence":"additional","affiliation":[{"name":"Department of Imaging Sciences and Biomedical Engineering, King\u2019s College London, United Kingdom (N.C., C.H.R., T.J., B.P., S.A.N., R.S.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza S.","family":"Razavi","sequence":"additional","affiliation":[{"name":"Department of Imaging Sciences and Biomedical Engineering, King\u2019s College London, United Kingdom (N.C., C.H.R., T.J., B.P., S.A.N., R.S.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher A.","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Guy\u2019s and St Thomas\u2019 Hospital, London, United Kingdom (J.B., C.A.R., M.J.W., J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Taggart","sequence":"additional","affiliation":[{"name":"University College London, United Kingdom (P.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Guy\u2019s and St Thomas\u2019 Hospital, London, United Kingdom (J.B., C.A.R., M.J.W., J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaswinder","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Guy\u2019s and St Thomas\u2019 Hospital, London, United Kingdom (J.B., C.A.R., M.J.W., J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.005119"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.98.10.946"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2015.07.002"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199809033391003"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eus027"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.03.021"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.110.961284"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1109\/TBME.2014.2350029"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.602870"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccep.2014.11.011"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-016-1766-4"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(64)90371-0"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.05.022"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.39.2.168"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)36723-6"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.945709"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2008.02.034"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.112.976654"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.98.12.1236"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.575340"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.005421"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.02.543"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht267"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.113.000318"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.115.002721"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.110.853804"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1038\/32164"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-013-1071-4"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13177"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.116.004899"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2015.09.017"}],"updated-by":[{"DOI":"10.1161\/hae.0000000000000030","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2018,8,21]],"date-time":"2018-08-21T00:00:00Z","timestamp":1534809600000}}],"container-title":["Circulation: Arrhythmia and Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCEP.117.005897","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T00:05:15Z","timestamp":1715558715000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCEP.117.005897"}},"subtitle":["Results From the STARLIGHT Study"],"short-title":[],"issued":{"date-parts":[[2018,6]]},"references-count":31,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2018,6]]}},"alternative-id":["10.1161\/CIRCEP.117.005897"],"URL":"https:\/\/doi.org\/10.1161\/circep.117.005897","relation":{"correction":[{"id-type":"doi","id":"10.1161\/HAE.0000000000000030","asserted-by":"object"}]},"ISSN":["1941-3149","1941-3084"],"issn-type":[{"value":"1941-3149","type":"print"},{"value":"1941-3084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6]]},"assertion":[{"value":"2017-09-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-03-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-06-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e005897"}}