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Fibrotic Tissue Properties associated with Atrial Fibrillation Rotors in Patients with Persistent Atrial Fibrillation
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  • Toshihiro Nakamura,
  • kunihiko kiuchi,
  • Koji Fukuzawa,
  • Mitsuru Takami,
  • yoshiaki watanabe,
  • Yu Izawa,
  • hideya suehiro,
  • tomomi akita,
  • makoto takemoto,
  • jun sakai,
  • atsusuke yatomi,
  • Yusuke Sonoda,
  • Hiroyuki Takahara,
  • Kazutaka Nakasone,
  • Kyoko Yamamoto,
  • noriyuki negi,
  • Atsushi Kono,
  • Takashi Ashihara,
  • Ken-ichi Hirata
Toshihiro Nakamura
Kobe University
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kunihiko kiuchi
Kobe University Graduate School of Medicine
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Koji Fukuzawa
Kobe University Graduate School of Medicine
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Mitsuru Takami
Kobe University Graduate School of Medicine
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yoshiaki watanabe
Kobe University Graduate School of Medicine
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Yu Izawa
Kobe University Graduate School of Medicine
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hideya suehiro
Kobe University Graduate School of Medicine
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tomomi akita
Kobe University Graduate School of Medicine
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makoto takemoto
Kobe University Graduate School of Medicine
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jun sakai
Kobe University Graduate School of Medicine
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atsusuke yatomi
Kobe University Graduate School of Medicine
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Yusuke Sonoda
Kobe University Graduate School of Medicine
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Hiroyuki Takahara
Kobe University Graduate School of Medicine
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Kazutaka Nakasone
Kobe University Graduate School of Medicine
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Kyoko Yamamoto
Kobe University Graduate School of Medicine
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noriyuki negi
Kobe University Hospital
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Atsushi Kono
Kobe University Graduate School of Medicine
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Takashi Ashihara
Shiga University of Medical Science
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Ken-ichi Hirata
Kobe University Graduate School of Medicine
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Abstract

Background: A computational model demonstrated that atrial fibrillation (AF) rotors could be distributed in patchy fibrotic tissue and play an important role in AF drivers. However, this was not validated in humans. Objective: The purpose of this study was to evaluate the fibrotic tissue properties of AF rotors in patients with persistent AF. Methods: A total of 287 segments in 15 patients with persistent AF (longstanding persistent AF in 9 patients) that underwent AF ablation were assessed. Non-passively activated areas (NPAs), where rotational activation (AF rotor) was frequently observed, were detected by the novel real-time phase mapping (ExTRa Mapping). Atrial fibrosis was detected by late-gadolinium enhancement magnetic resonance imaging (LGE-MRI), and the fibrotic heterogeneity and density were assessed by the entropy (LGE-entropy) and volume ratio of the enhancement voxel (LGE-volume ratio), respectively. Results: NPAs were found in 61 (21%) of 287 segments and were mostly found around the pulmonary vein antrum. A receiver operating characteristic curve analysis yielded an optimal cutoff value of 5.7 and 10% for the LGE-entropy and LGE-volume ratio, respectively. The incidence of NPAs was significantly higher at segments with an LGE-entropy of >5.7 and LGE-volume ratio of >10% than at the other segments (38 [30%] of 126 vs. 23 [14%] of 161 segments, p = 0.001). No NPAs were found at segments with an LGE-volume ratio of >50% regardless of the LGE-entropy. Conclusion: AF rotors are mostly distributed in relatively weak and much more heterogenous fibrotic tissue.

Peer review status:ACCEPTED

25 Nov 2020Submitted to Journal of Cardiovascular Electrophysiology
26 Nov 2020Submission Checks Completed
26 Nov 2020Assigned to Editor
29 Nov 2020Reviewer(s) Assigned
12 Dec 2020Review(s) Completed, Editorial Evaluation Pending
14 Dec 2020Editorial Decision: Revise Minor
11 Jan 20211st Revision Received
13 Jan 2021Submission Checks Completed
13 Jan 2021Assigned to Editor
13 Jan 2021Reviewer(s) Assigned
20 Jan 2021Review(s) Completed, Editorial Evaluation Pending
21 Jan 2021Editorial Decision: Accept