{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T19:54:53Z","timestamp":1766087693978,"version":"3.37.3"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004374","name":"Medtronic","doi-asserted-by":"publisher","award":["AF-3613"],"award-info":[{"award-number":["AF-3613"]}],"id":[{"id":"10.13039\/100004374","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>We evaluated the effect of adenosine upon mechanisms sustaining persistent AF through analysis of contact electrograms and ECGI mapping.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Persistent AF patients undergoing catheter ablation were included. ECGI maps and cycle length (CL) measurements were recorded in the left and right atrial appendages and repeated following boluses of 18 mg of intravenous adenosine. Potential drivers (PDs) were defined as focal or rotational activations completing \u2265 1.5 revolutions. Distribution of PDs was assessed using an 18 segment biatrial model.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>46 patients were enrolled. Mean age was 63.4 \u00b1 9.8 years with 33 (72%) being male. There was no significant difference in the number of PDs recorded at baseline compared to adenosine (42.1 \u00b1 15.2 vs 40.4 \u00b1 13.0; p = 0.417), nor in the number of segments harbouring PDs, (13 (11\u201314) vs 12 (10\u201314); p = 0.169). There was a significantly higher percentage of PDs that were focal in the adenosine maps (36.2 \u00b1 15.2 vs 32.2 \u00b1 14.4; p &lt; 0.001). There was a significant shortening of CL in the adenosine maps compared to baseline which was more marked in the right atrium than left atrium (176.7 \u00b1 34.7 vs 149.9 \u00b1 27.7 ms; p &lt; 0.001 and 165.6 \u00b1 31.7 vs 148.3 \u00b1 28.4 ms; p = 0.003).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Adenosine led to a small but significant shortening of CL which was more marked in the right than left atrium and may relate to shortening of refractory periods rather than an increase in driver burden or distribution.<\/jats:p>\n<jats:p>Registered on Clinicaltrials.gov: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03394404\" xlink:type=\"simple\">NCT03394404<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0248951","type":"journal-article","created":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T20:06:59Z","timestamp":1616702819000},"page":"e0248951","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of adenosine on mechanisms sustaining persistent atrial fibrillation: Analysis of contact electrograms and non-invasive ECGI mapping data"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1197-9328","authenticated-orcid":true,"given":"Gurpreet Singh","family":"Dhillon","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1257-5576","authenticated-orcid":true,"given":"Nikhil","family":"Ahluwalia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shohreh","family":"Honarbakhsh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Graham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Creta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hakam","family":"Abbass","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Chow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark J.","family":"Earley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pier D.","family":"Lambiase","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard J.","family":"Schilling","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ross J.","family":"Hunter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,3,25]]},"reference":[{"key":"pone.0248951.ref001","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.jacep.2017.09.177","article-title":"A Novel Mapping System for Panoramic Mapping of the Left Atrium","volume":"4","author":"S Honarbakhsh","year":"2018","journal-title":"JACC Clin Electrophysiol"},{"key":"pone.0248951.ref002","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/j.jacep.2019.04.007","article-title":"Ablation in Persistent Atrial Fibrillation Using Stochastic Trajectory Analysis of Ranked Signals (STAR) Mapping Method","volume":"5","author":"S Honarbakhsh","year":"2019","journal-title":"JACC Clin Electrophysiol"},{"key":"pone.0248951.ref003","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1161\/CIRCULATIONAHA.113.005421","article-title":"Driver Domains in Persistent Atrial Fibrillation","volume":"130","author":"M Haissaguerre","year":"2014","journal-title":"Circulation"},{"key":"pone.0248951.ref004","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1016\/j.jacc.2017.01.014","article-title":"Complexity and Distribution of Drivers in Relation to Duration of Persistent Atrial Fibrillation","volume":"69","author":"HS Lim","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"pone.0248951.ref005","first-page":"1302","article-title":"Multicentre evaluation of non-invasive biatrial mapping for persistent atrial fibrillation ablation: the AFACART study","author":"S Knecht","year":"2017","journal-title":"EP Eur"},{"key":"pone.0248951.ref006","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1161\/01.CIR.83.5.1499","article-title":"Cardiac electrophysiology of adenosine. 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