{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T02:34:27Z","timestamp":1788489267184,"version":"build-2803163510"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Localized 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Each patient (63.6\u00b18.5 years, 29.6% women) showed 4.0\u00b12.1 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 (\n              <jats:italic>P<\/jats:italic>\n              =0.02 in left atrium).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Wavefront 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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.118.006835","type":"journal-article","created":{"date-parts":[[2019,7,29]],"date-time":"2019-07-29T09:00:13Z","timestamp":1564390813000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Wavefront Field Mapping Reveals a Physiologic Network Between Drivers Where Ablation Terminates Atrial Fibrillation"],"prefix":"10.1161","volume":"12","author":[{"given":"George","family":"Leef","sequence":"first","affiliation":[{"name":"Department 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.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemah","family":"Shenasa","sequence":"additional","affiliation":[{"name":"Department 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.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neal K.","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Department 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.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert J.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Department 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.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Sauer","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Colorado, Denver (W.S., E.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Indiana, Indianapolis (J.M.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Swerdlow","sequence":"additional","affiliation":[{"name":"Department 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.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mallika","family":"Tamboli","sequence":"additional","affiliation":[{"name":"Department 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.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmood I.","family":"Alhusseini","sequence":"additional","affiliation":[{"name":"Department 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.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Armenia","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Colorado, Denver (W.S., E.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Baykaner","sequence":"additional","affiliation":[{"name":"Department 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.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Brachmann","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Klinikum Coburg, Germany (J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mintu P.","family":"Turakhia","sequence":"additional","affiliation":[{"name":"Department of Medicine, Veterans Affairs Palo Alto Health Care System, CA (M.P.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Atienza","sequence":"additional","affiliation":[{"name":"Departamento de Cardiologia, Hospital General Universitario Gregorio Maranon, Madrid, Spain (F.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wouter-Jan","family":"Rappel","sequence":"additional","affiliation":[{"name":"Department of Physics, University of California, San Diego (W.J.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department 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.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjiv M.","family":"Narayan","sequence":"additional","affiliation":[{"name":"Department 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.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.310489"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eux297"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.05.012"},{"key":"e_1_3_3_5_2","first-page":"B-LBCT01-05","article-title":"Catheter ablation vs. antiarrhythmic drug therapy for atrial fibrillation: the results of the cabana multicenter international randomized clinical trial.","volume":"19","author":"Packer DL","year":"2018","unstructured":"Packer, DL, Mark, DB, Robb, RA, Monahan, KH, Holmes, DR, III, Bahnson, TD, Poole, JE, Rettmann, M, Rosenberg, Y, Jeffries, N, et al. Catheter ablation vs. antiarrhythmic drug therapy for atrial fibrillation: the results of the cabana multicenter international randomized clinical trial. Heart Rhythm. 2018;19:B-LBCT01-05.","journal-title":"Heart Rhythm"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13331"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.005421"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2016.08.005"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.05.022"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2016.08.001"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.10.065"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2017.09.177"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.11.079"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13313"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.117.006119"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eux370"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.021165"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv233"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.117.005846"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1103\/PhysRevE.94.050401"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1109\/TBME.2014.2350029"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.07.057"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13177"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13446"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.117.005258"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.116.004409"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12474"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.19102\/icrm.2015.061104"},{"key":"e_1_3_3_29_2","first-page":"PO01-58","article-title":"Acute and short-term outcomes in persistent and long-standing persistent patients undergoing rotors only ablation.","volume":"12","author":"Gianni C","year":"2015","unstructured":"Gianni, C, Di Biase, L, Deneke, T, Tami Metz, T, Halbfass, P, M\u00fcller, P, Schade, A, Mohanty, S, Trivedi, C, Bai, R, et al. Acute and short-term outcomes in persistent and long-standing persistent patients undergoing rotors only ablation. Heart Rhythm. 2015;12:PO01-58. Abstract.","journal-title":"Heart Rhythm"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.115.002956"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2018.08.024"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.3"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.89.4.1665"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2016.12.033"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1111\/pace.12009"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp063"},{"key":"e_1_3_3_37_2","first-page":"S577","article-title":"Complementation of atrial fibrillation source location by combining simultaneous endocardial basket and body surface mapping.","volume":"15","author":"Rodrigo M","year":"2018","unstructured":"Rodrigo, M, Climent, A, Hernandez-Romero, I, Kowalewski, C, Baykaner, T, Rappel, W-J, Guillem, M, Atienza, F,Narayan, SM. Complementation of atrial fibrillation source location by combining simultaneous endocardial basket and body surface mapping. Heart Rhythm. 2018;15:S577. Abstract.","journal-title":"Heart Rhythm"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2005.00307.x"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.116.004899"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1063\/1.4807098"}],"container-title":["Circulation: Arrhythmia and Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCEP.118.006835","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T00:03:35Z","timestamp":1715558615000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCEP.118.006835"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8]]},"references-count":39,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1161\/CIRCEP.118.006835"],"URL":"https:\/\/doi.org\/10.1161\/circep.118.006835","relation":{},"ISSN":["1941-3149","1941-3084"],"issn-type":[{"value":"1941-3149","type":"print"},{"value":"1941-3084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8]]},"assertion":[{"value":"2018-08-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-04-30","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-07-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e006835"}}