A TECHNIQUE FOR MEASUREMENT OF THE EXTENT OF SPATIAL-ORGANIZATION OF ATRIAL ACTIVATION DURING ATRIAL-FIBRILLATION IN THE INTACT HUMAN HEART

Atrial fibrillation (AF) is a common clinical problem, associated with considerable morbidity and mortality, for which effective management strategies have yet to be devised, The absence of objective measures t o guide selection of antiarrhythmic drug therapy for maintenance of si nus rhythm leaves only clinical endpoints (either beneficial or detrim ental) for assessment of drug action, with occasional catastrophic con sequences. As part of an attempt to provide an objective framework for the assessment of antiarrhythmic drug action on the electrophysiologi c determinants of atrial fibrillation, we have developed a measure of the spatial organization of atrial activation processes during atrial fibrillation. By recording activation sequences at multiple equally sp aced locations on the endocardial surface of the atria during atrial f ibrillation in humans and determining the degree of correlation betwee n these activation sequences as a function of distance, we have been a ble to construct spatial correlation functions for atrial activation, We have found that atrial activation remains well-correlated, independ ent of distance during normal sinus rhythm and atrial flutter, During atrial fibrillation, correlation decays monotonically with distance an d the space-constant for this decay may be used to describe the relati ve spatial organization of atrial fibrillation. We provide examples of the impact of antiarrhythmic agents on the space-constant and suggest that assessment of the relative spatial organization of atrial activa tion using this methodology may potentially provide an objective frame work to guide therapy in patients with AF.