Letter by Ganesan et al Regarding Article, "Wavefront Field Mapping Reveals a Physiologic Network Between Drivers Where Ablation Terminates Atrial Fibrillation".

A. Ganesan, D. Dharmaprani, A. McGavigan
{"title":"Letter by Ganesan et al Regarding Article, \"Wavefront Field Mapping Reveals a Physiologic Network Between Drivers Where Ablation Terminates Atrial Fibrillation\".","authors":"A. Ganesan, D. Dharmaprani, A. McGavigan","doi":"10.1161/CIRCEP.119.007930","DOIUrl":null,"url":null,"abstract":"November 2019 1 Anand N. Ganesan, MBBS, PhD Dhani Dharmaprani, BEng Andrew D. McGavigan, MD To the Editor: Leef et al1 present an important study using wavefront field mapping to reveal a physiological network between drivers in cases where atrial fibrillation terminates. The directed vector approach utilized to demonstrate the connection of counterchiral spiral waves recalls the topological restrictions on phase singularities (PSs), outlined by Gray et al2: (1) phase lines cannot intersect; (2) PSs are joined by other isophasic lines to PS of opposite chirality or nonconducting boundaries; (3) PSs form and terminate as oppositely rotating pairs. Given the intrinsic topological connectedness of counter-chiral spiral waves via isophasic lines, it would be interesting to study these phenomena in cases where termination did not occur because these may also be present in the absence of AF termination. This is certainly a feature observable in the phase maps presented by Child et al.3 A further point addressed during the study is fluctuating nature of PS, which the authors postulated occurs via undefined mechanisms.1 In fact, the fluctuation of PS may potentially be an intrinsic topological property. Because each PS creates zones where all phases of the cycle are simultaneously present, the timing of incoming waves is likely to stochastically encounter tissue in the critical phase for new wavebreak and thus cause a new PS to form.4 This creates an endless cycle of PS regeneration that is a feature of the perpetuation of AF and VF.5 A final point made by Winfree4 and Gray et al2 is on the nature of PS termination. For topological reasons, PS termination can only occur via fusion with a wave emanating from a migrating spiral or migration to a boundary. The ability to terminate the arrhythmia at a distance from the PS observed by Leef et al could equally be consistent with the notion that AF termination is a form of stochastic ergodicity breaking, rather than via a direct effect on individual PS. The interesting approach presented by Leef et al points to the need for further studies of the mechanisms of AF and VF termination.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"25 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Arrhythmia and Electrophysiology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1161/CIRCEP.119.007930","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 2

Abstract

November 2019 1 Anand N. Ganesan, MBBS, PhD Dhani Dharmaprani, BEng Andrew D. McGavigan, MD To the Editor: Leef et al1 present an important study using wavefront field mapping to reveal a physiological network between drivers in cases where atrial fibrillation terminates. The directed vector approach utilized to demonstrate the connection of counterchiral spiral waves recalls the topological restrictions on phase singularities (PSs), outlined by Gray et al2: (1) phase lines cannot intersect; (2) PSs are joined by other isophasic lines to PS of opposite chirality or nonconducting boundaries; (3) PSs form and terminate as oppositely rotating pairs. Given the intrinsic topological connectedness of counter-chiral spiral waves via isophasic lines, it would be interesting to study these phenomena in cases where termination did not occur because these may also be present in the absence of AF termination. This is certainly a feature observable in the phase maps presented by Child et al.3 A further point addressed during the study is fluctuating nature of PS, which the authors postulated occurs via undefined mechanisms.1 In fact, the fluctuation of PS may potentially be an intrinsic topological property. Because each PS creates zones where all phases of the cycle are simultaneously present, the timing of incoming waves is likely to stochastically encounter tissue in the critical phase for new wavebreak and thus cause a new PS to form.4 This creates an endless cycle of PS regeneration that is a feature of the perpetuation of AF and VF.5 A final point made by Winfree4 and Gray et al2 is on the nature of PS termination. For topological reasons, PS termination can only occur via fusion with a wave emanating from a migrating spiral or migration to a boundary. The ability to terminate the arrhythmia at a distance from the PS observed by Leef et al could equally be consistent with the notion that AF termination is a form of stochastic ergodicity breaking, rather than via a direct effect on individual PS. The interesting approach presented by Leef et al points to the need for further studies of the mechanisms of AF and VF termination.
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Ganesan等人关于文章“波前场映射揭示了消融终止心房颤动的驱动因素之间的生理网络”的信。
2019年11月1 Anand N. Ganesan, MBBS, Dhani Dharmaprani博士,BEng Andrew D. McGavigan医学博士致编辑:Leef等人1提出了一项重要的研究,使用波前场映射来揭示心房颤动终止病例中驾驶员之间的生理网络。用于证明反手性螺旋波的连接的有向矢量方法使人想起了Gray等人提出的相位奇点(ps)的拓扑限制:(1)相位线不能相交;(2) PS通过其他等相线连接到具有相反手性或不导电边界的PS;(3) ps形成和终止为反向旋转对。考虑到反手性螺旋波通过等相线的固有拓扑连通性,在没有发生终止的情况下研究这些现象将是有趣的,因为这些现象也可能存在于没有AF终止的情况下。这当然是Child等人提出的相位图中可以观察到的一个特征。3研究中进一步提到的一点是PS的波动性,作者认为这是通过未定义的机制发生的事实上,PS的波动可能是一种内在的拓扑性质。因为每一个PS都产生了一个区域,在这个区域内所有周期的相位都同时存在,所以入射波的时间很可能在新波破裂的关键阶段随机遇到组织,从而导致新的PS形成这创造了一个无限的PS再生循环,这是AF和VF.5永久存在的特征。Winfree4和Gray等人提出的最后一点是PS终止的本质。由于拓扑原因,PS终止只能通过与从迁移螺旋或迁移到边界发出的波融合而发生。Leef等人所观察到的在离心室远的地方终止心律失常的能力也可能与心房颤动终止是一种随机的遍历性中断的形式,而不是通过对个体心室颤动的直接影响这一概念相一致。Leef等人提出的有趣方法指出,需要进一步研究心房颤动和心室颤动终止的机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Coronary Sinus Metabolite 12,13-diHOME Is a Novel Biomarker for Left Atrial Remodeling in Patients With Atrial Fibrillation Impact of Contact Force on Pulsed Field Ablation Outcomes Using Focal Point Catheter Characteristics of Right-Sided Accessory Pathways Associated With Right Cardiac Veins Prognostic Impact of Sinus Rhythm in Atrial Fibrillation Patients: Separating Rhythm Outcomes From Randomized Strategy Findings From the CABANA Trial Trends Favoring an Anatomical Approach to Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1