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Intermittent drivers anchoring to structural heterogeneities as a major pathophysiological mechanism of human persistent atrial fibrillation

hal.structure.identifierIHU-LIRYC
dc.contributor.authorHAÏSSAGUERRE, Michel
hal.structure.identifierDépartement de cardiologie
dc.contributor.authorSHAH, Ashok
hal.structure.identifierAgroParisTech
dc.contributor.authorCOCHET, Hubert
hal.structure.identifierIHU-LIRYC
dc.contributor.authorHOCINI, Mélèze
hal.structure.identifierIHU-LIRYC
hal.structure.identifierWashington University in Saint Louis [WUSTL]
dc.contributor.authorDUBOIS, Rémi
hal.structure.identifierModélisation et calculs pour l'électrophysiologie cardiaque [CARMEN]
dc.contributor.authorVIGMOND, Edward
hal.structure.identifierIHU-LIRYC
dc.contributor.authorBERNUS, Olivier
hal.structure.identifierJohns Hopkins University [JHU]
dc.contributor.authorTRAYANOVA, Natalia
dc.date.accessioned2024-04-04T02:51:11Z
dc.date.available2024-04-04T02:51:11Z
dc.date.issued2016-05-01
dc.identifier.issn0022-3751
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/191973
dc.description.abstractEnThe mechanisms responsible for perpetuation of human persistent atrial fibrillation (AF) are controversial and probably vary between individuals. A wide spectrum of mechanisms have been described in experimental studies, ranging from a single localized stable (focal/reentrant) source, to multiple sources, up to diffuse bi-atrial wavelets. We characterized AF drivers in patients with persistent AF (lasting less than 1 year) using novel high resolution mapping, imaging and modelling approaches with the objective of evaluating their relationship to atrial structural heterogeneities. Using panoramic non-invasive mapping in humans, focal or reentrant sources driving AF waves were identified, originating from multiple distinct regions and exhibiting short lifespans and periodic recurrences in the same locations. The reentrant driver regions harboured long, fractionated electrograms covering most of the fibrillatory cycle lengths with varying beat-to-beat sequences suggestive of unstable trajectories attached to slow conducting heterogeneous tissue. MRI atrial imaging demonstrated that such drivers preferentially clustered at the borders of fibrotic atrial regions. In patient-specific computer simulations, sustained AF was shown to be driven by meandering transitory reentries attached to fibrosis borders expressing specific metrics in density and extent. Finally, random microstructural alterations devoid of cellular electrical changes were modelled, showing that a percolation mechanism could also explain atrial reentries and complex fractionated electrograms. These data from clinical, imaging and computational studies strongly suggest that intermittent and spatially unstable drivers anchoring to structural heterogeneities are a major pathophysiological mechanism in human persistent atrial fibrillation.
dc.language.isoen
dc.publisherWiley
dc.title.enIntermittent drivers anchoring to structural heterogeneities as a major pathophysiological mechanism of human persistent atrial fibrillation
dc.typeArticle de revue
dc.identifier.doi10.1113/JP270617
dc.subject.halSciences du Vivant [q-bio]/Médecine humaine et pathologie/Cardiologie et système cardiovasculaire
bordeaux.journalThe Journal of Physiology
bordeaux.page2387-2398
bordeaux.volume594
bordeaux.hal.laboratoriesInstitut de Mathématiques de Bordeaux (IMB) - UMR 5251*
bordeaux.issue9
bordeaux.institutionUniversité de Bordeaux
bordeaux.institutionBordeaux INP
bordeaux.institutionCNRS
bordeaux.peerReviewedoui
hal.identifierhal-02886250
hal.version1
hal.popularnon
hal.audienceInternationale
hal.origin.linkhttps://hal.archives-ouvertes.fr//hal-02886250v1
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