{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T03:26:51Z","timestamp":1791516411367,"version":"4.3.4"},"reference-count":20,"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":[[2020,8]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Endocardial-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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Simultaneous 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 \u226520 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 \u22655 directional changes occupying at least 70% of sample duration.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Fourteen 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%,\n              <jats:italic>P<\/jats:italic>\n              =0.0194) and single wavefronts (Endo: 31.3% versus Epi: 28.1%,\n              <jats:italic>P<\/jats:italic>\n              =0.129) were the dominant patterns. Transient rotations (Endo: 22% versus Epi: 19.2%,\n              <jats:italic>P<\/jats:italic>\n              =0.169; mean duration: 590\u00b1140 ms) and nonsustained focal waves (Endo: 1.2% versus Epi: 1.6%,\n              <jats:italic>P<\/jats:italic>\n              =0.669) were also observed. Apparent transmural migration of rotational activations (n=6) from the epi- to the endocardium was seen in 2 patients. Electrogram fractionation was significantly higher in the epicardium than endocardium (61.2% versus 51.6%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Simultaneous 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphic Abstract:<\/jats:title>\n            <jats:p>\n              A\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"graphic abstract\">graphic abstract<\/jats:ext-link>\n              is available for this article.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.120.008512","type":"journal-article","created":{"date-parts":[[2020,7,7]],"date-time":"2020-07-07T18:00:21Z","timestamp":1594144821000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Endocardial-Epicardial Phase Mapping of Prolonged Persistent Atrial Fibrillation Recordings"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3941-6199","authenticated-orcid":true,"given":"Ramanathan","family":"Parameswaran","sequence":"first","affiliation":[{"name":"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.)"},{"name":"Department 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.)"},{"name":"Heart Centre, Alfred Hospital (R.P., A.V., H.S., D.C., P.M.K.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6618-7184","authenticated-orcid":true,"given":"Jonathan M.","family":"Kalman","sequence":"additional","affiliation":[{"name":"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.)"},{"name":"Department 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.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4449-663X","authenticated-orcid":true,"given":"Alistair","family":"Royse","sequence":"additional","affiliation":[{"name":"Department 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.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4738-9685","authenticated-orcid":true,"given":"John","family":"Goldblatt","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Royal Melbourne Hospital (A.R., J.G., M.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Larobina","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Royal Melbourne Hospital (A.R., J.G., M.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy","family":"Watts","sequence":"additional","affiliation":[{"name":"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.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6236-1405","authenticated-orcid":true,"given":"Tomos E.","family":"Walters","sequence":"additional","affiliation":[{"name":"Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco (T.E.W., E.P.G)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chrishan J.","family":"Nalliah","sequence":"additional","affiliation":[{"name":"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.)"},{"name":"Department 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.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9733-7712","authenticated-orcid":true,"given":"Geoffrey","family":"Wong","sequence":"additional","affiliation":[{"name":"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.)"},{"name":"Department 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.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5174-1034","authenticated-orcid":true,"given":"Ahmed","family":"Al-Kaisey","sequence":"additional","affiliation":[{"name":"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.)"},{"name":"Department 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., 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Arrhythmia and Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCEP.120.008512","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T01:17:47Z","timestamp":1715563067000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCEP.120.008512"}},"subtitle":["High Prevalence of Dissociated Activation Patterns"],"short-title":[],"issued":{"date-parts":[[2020,8]]},"references-count":20,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2020,8]]}},"alternative-id":["10.1161\/CIRCEP.120.008512"],"URL":"https:\/\/doi.org\/10.1161\/circep.120.008512","relation":{},"ISSN":["1941-3149","1941-3084"],"issn-type":[{"value":"1941-3149","type":"print"},{"value":"1941-3084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8]]},"assertion":[{"value":"2020-02-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-05-30","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-07-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e008512"}}