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  1. Article ; Online: Pathophysiology of atrial fibrillation: Focal patterns of activation.

    de Groot, Natasja M S / Allessie, Maurits A

    Pacing and clinical electrophysiology : PACE

    2019  Volume 42, Issue 10, Page(s) 1312–1319

    Abstract: For decades, electrical activity recorded has been investigated to unravel pathophysiology of cardiac arrhythmias, such as atrial fibrillation (AF). Particularly high-resolution mapping studies have significantly contributed to novel insights into AF ... ...

    Abstract For decades, electrical activity recorded has been investigated to unravel pathophysiology of cardiac arrhythmias, such as atrial fibrillation (AF). Particularly high-resolution mapping studies have significantly contributed to novel insights into AF mechanisms. From these mapping studies, it appeared that persistence of AF is associated with a high incidence of focal patterns of activation. Features of these focal activation patterns indicated that they could be attributed to transmural propagation of fibrillation waves. However, "focal fibrillation waves" can only appear when there is electrical asynchrony between the endocardial and epicardial layer. By performing simultaneous high-resolution mapping of the endo- and epicardial wall of the right atrium in humans during AF, the existence of electrical asynchrony (endo-epicardial asynchrony [EEA]) between the endo- and epicardial layer was indeed confirmed. During sinus rhythm, focal patterns of activation are most frequently observed at the right atrium and a considerable degree of EEA-as large as 50 ms-may occur. Furthermore, prematurely aberrant atrial extrasystoles emerging as focal waves caused the highest degree of conduction disorders, particularly in patients with left atrial dilatation and diabetes mellitus. These observations emphasize the contribution of atrial anatomy to EEA and the role of focal patterns of activation in development AF.
    MeSH term(s) Atrial Fibrillation/physiopathology ; Body Surface Potential Mapping ; Electrocardiography ; Epicardial Mapping ; Heart Conduction System/physiopathology ; Humans
    Language English
    Publishing date 2019-08-25
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 424437-0
    ISSN 1540-8159 ; 0147-8389
    ISSN (online) 1540-8159
    ISSN 0147-8389
    DOI 10.1111/pace.13777
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  2. Article ; Online: Dynamics of Focal Fibrillation Waves during Persistent Atrial Fibrillation.

    Lanters, Eva A H / Allessie, Maurits A / DE Groot, Natasja M S

    Pacing and clinical electrophysiology : PACE

    2016  Volume 39, Issue 4, Page(s) 403–404

    Abstract: The incidence and appearance of focal fibrillation waves on the right and left atrial epicardial surface were visualized during 10 seconds of persistent atrial fibrillation in a 71-year-old woman with valvular heart disease. The frequent, nonrepetitive, ... ...

    Abstract The incidence and appearance of focal fibrillation waves on the right and left atrial epicardial surface were visualized during 10 seconds of persistent atrial fibrillation in a 71-year-old woman with valvular heart disease. The frequent, nonrepetitive, widespread, and capricious distribution of focal waves suggests that transmural conduction of fibrillation waves is most likely the mechanism underlying focal fibrillation waves.
    MeSH term(s) Aged ; Atrial Fibrillation/diagnostic imaging ; Atrial Fibrillation/physiopathology ; Chronic Disease ; Epicardial Mapping/methods ; Female ; Heart Atria/diagnostic imaging ; Heart Atria/physiopathology ; Heart Conduction System/physiopathology ; Humans
    Language English
    Publishing date 2016-04
    Publishing country United States
    Document type Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 424437-0
    ISSN 1540-8159 ; 0147-8389
    ISSN (online) 1540-8159
    ISSN 0147-8389
    DOI 10.1111/pace.12807
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  3. Article: Atrial fibrillation-induced electrical remodeling in humans: what is the next step?

    Allessie, M A

    Cardiovascular research

    1999  Volume 44, Issue 1, Page(s) 10–12

    MeSH term(s) Action Potentials ; Atrial Fibrillation/physiopathology ; Calcium Channels ; Chronic Disease ; Heart/physiopathology ; Humans ; Ion Channels ; Membrane Potentials ; Potassium Channels
    Chemical Substances Calcium Channels ; Ion Channels ; Potassium Channels
    Language English
    Publishing date 1999-10
    Publishing country England
    Document type Editorial
    ZDB-ID 80340-6
    ISSN 1755-3245 ; 0008-6363
    ISSN (online) 1755-3245
    ISSN 0008-6363
    DOI 10.1016/s0008-6363(99)00244-8
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  4. Article: Atrial electrophysiologic remodeling: another vicious circle?

    Allessie, M A

    Journal of cardiovascular electrophysiology

    1998  Volume 9, Issue 12, Page(s) 1378–1393

    Abstract: Introduction: With few exceptions, acquired heart disease is the result of gradual changes in the heart, progressing during several months or years. This also includes certain cardiac arrhythmias, as for instance atrial fibrillation (AF). In spite of ... ...

    Abstract Introduction: With few exceptions, acquired heart disease is the result of gradual changes in the heart, progressing during several months or years. This also includes certain cardiac arrhythmias, as for instance atrial fibrillation (AF). In spite of the important role of slowly progressing pathologic processes, most of our knowledge about mechanisms of cardiac arrhythmias is based on acute experiments. Only recently, the attention also is more focused on long-term adaptation processes like cardiac memory, electrical remodeling, and tachycardia-induced cardiomyopathy. In experimental animal models, it has been shown that AF induces a vicious circle of electrophysiologic and structural changes that inevitably leads to "domestication" of the arrhythmia ("AF begets AF"). In this article, the studies on AF-induced electrophysiologic and cellular remodeling are discussed.
    MeSH term(s) Animals ; Atrial Fibrillation/physiopathology ; Atrial Function/physiology ; Calcium Channels/physiology ; Disease Models, Animal ; Electrophysiology ; Gap Junctions/physiology ; Humans ; Models, Cardiovascular ; Refractory Period, Electrophysiological/physiology
    Chemical Substances Calcium Channels
    Language English
    Publishing date 1998-12
    Publishing country United States
    Document type Journal Article ; Lecture ; Review
    ZDB-ID 1025989-2
    ISSN 1540-8167 ; 1045-3873
    ISSN (online) 1540-8167
    ISSN 1045-3873
    DOI 10.1111/j.1540-8167.1998.tb00114.x
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  5. Article: Is atrial fibrillation sometimes a genetic disease?

    Allessie, M A

    The New England journal of medicine

    1997  Volume 336, Issue 13, Page(s) 950–952

    MeSH term(s) Atrial Fibrillation/genetics ; Atrial Fibrillation/physiopathology ; Chromosomes, Human, Pair 10 ; Humans ; Mutation
    Language English
    Publishing date 1997-03-27
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJM199703273361310
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  6. Article ; Online: Dynamics of Endo- and Epicardial Focal Fibrillation Waves at the Right Atrium in a Patient With Advanced Atrial Remodelling.

    van der Does, Lisette J M E / Kik, Charles / Bogers, Ad J J C / Allessie, Maurits A / de Groot, Natasja M S

    The Canadian journal of cardiology

    2016  Volume 32, Issue 10, Page(s) 1260.e19–1260.e21

    Abstract: Focal waves appear frequently at the epicardium during persistent atrial fibrillation (AF), however, the origin of these waves is under debate. We performed simultaneous endo-epicardial mapping of the right atrial wall during longstanding persistent AF ... ...

    Abstract Focal waves appear frequently at the epicardium during persistent atrial fibrillation (AF), however, the origin of these waves is under debate. We performed simultaneous endo-epicardial mapping of the right atrial wall during longstanding persistent AF in a patient undergoing cardiac surgery. During 10 seconds 53 and 59 focal waves appeared at random at respectively the endocardium and epicardium. Repetitive focal activity did not last longer than 3 cycles. Transmural asynchrony and conduction might be the origin of focal waves. Asynchronous propagation of fibrillation waves in 3 dimensions would stabilize the arrhythmia and could explain the limited success of persistent AF ablation.
    MeSH term(s) Atrial Fibrillation/physiopathology ; Atrial Remodeling/physiology ; Body Surface Potential Mapping ; Endocardium/physiopathology ; Female ; Heart Atria/physiopathology ; Humans ; Middle Aged ; Pericardium/physiopathology
    Language English
    Publishing date 2016-10
    Publishing country England
    Document type Case Reports ; Journal Article ; Video-Audio Media
    ZDB-ID 632813-1
    ISSN 1916-7075 ; 0828-282X
    ISSN (online) 1916-7075
    ISSN 0828-282X
    DOI 10.1016/j.cjca.2015.11.020
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  7. Article: Diagnosis and Therapy of Atrial Fibrillation: The Past, The Present and The Future.

    van Marion, Denise M S / Lanters, Eva A H / Wiersma, Marit / Allessie, Maurits A / Brundel, Bianca B J J M / de Groot, Natasja M S

    Journal of atrial fibrillation

    2015  Volume 8, Issue 2, Page(s) 1216

    Abstract: Atrial fibrillation (AF) is the most common age-related cardiac arrhythmia. It is a progressive disease, which makes treatment difficult. The progression of AF is caused by the accumulation of damage in cardiomyocytes which makes the atria more ... ...

    Abstract Atrial fibrillation (AF) is the most common age-related cardiac arrhythmia. It is a progressive disease, which makes treatment difficult. The progression of AF is caused by the accumulation of damage in cardiomyocytes which makes the atria more vulnerable for AF. Especially structural remodeling and electrical remodeling, together called electropathology are sustainable in the atria and impair functional recovery to sinus rhythm after cardioversion. The exact electropathological mechanisms underlying persistence of AF are at present unknown. High resolution wavemapping studies in patients with different types of AF showed that longitudinal dissociation in conduction and epicardial breakthrough were the key elements of the substrate of longstanding persistent AF. A double layer of electrically dissociated waves propagating transmurally can explain persistence of AF (Double Layer Hypothesis) but the molecular mechanism is unknown. Derailment of proteasis -defined as the homeostasis in protein synthesis, folding, assembly, trafficking, guided by chaperones, and clearance by protein degradation systems - may play an important role in remodeling of the cardiomyocyte. As current therapies are not effective in attenuating AF progression, step-by-step analysis of this process, in order to identify potential targets for drug therapy, is essential. In addition, novel mapping approaches enabling assessment of the degree of electropathology in the individual patient are mandatory to develop patient-tailored therapies. The aims of this review are to 1) summarize current knowledge of the electrical and molecular mechanisms underlying AF 2) discuss the shortcomings of present diagnostic instruments and therapeutic options and 3) to present potential novel diagnostic tools and therapeutic targets.
    Language English
    Publishing date 2015-08-31
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 2451936-4
    ISSN 1941-6911
    ISSN 1941-6911
    DOI 10.4022/jafib.1216
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  8. Article ; Online: Analysis of fractionated atrial fibrillation electrograms by wavelet decomposition.

    Houben, Richard P M / de Groot, Natasja M S / Allessie, Maurits A

    IEEE transactions on bio-medical engineering

    2010  Volume 57, Issue 6, Page(s) 1388–1398

    Abstract: This study introduces the use of wavelet decomposition of unipolar fibrillation electrograms for the automatic detection of local activation times during complex atrial fibrillation (AF). The purpose of this study was to evaluate this technique in ... ...

    Abstract This study introduces the use of wavelet decomposition of unipolar fibrillation electrograms for the automatic detection of local activation times during complex atrial fibrillation (AF). The purpose of this study was to evaluate this technique in patients with structural heart disease and longstanding persistent AF. In 46 patients undergoing cardiac surgery, unipolar fibrillation electrograms were recorded from the right atrium, using a mapping array of 244 electrodes. In 25 patients with normal sinus rhythm, AF was induced by rapid pacing, whereas 21 patients were in persistent AF. In patients with longstanding AF, the atrial electrograms showed a high degree of fractionation. In each patient, 12 s of AF were analyzed by wavelet transformation (15 scales). The finest scales (1-7) were used to reconstruct a "local" fibrillation electrogram, whereas with the coarse scales (9-15), a far-field signal was generated. With these local and far-field electrograms, the "primary" fibrillation potentials, due to wave propagation underneath the electrode, could be distinguished from double potentials and multiple components generated by remote wavefronts. Wavelet transformation resulted in AF histograms with a closely gaussian distribution and the automatically generated activation maps showed a good resemblance with fibrillation maps obtained by laborious manual editing. A special chaining algorithm was developed to detect multiple components in fractionated electrograms. The degree of fractionation showed a positive correlation with the complexity of fibrillation, thus providing an objective quantification of the degree of electrical dissociation of the atria. Wavelet transformation can be a useful technique to detect the primary potentials and quantify the degree of fractionation of fibrillation electrograms. This could enable real-time mapping of complex cases of human AF and classification of the underlying electropathological substrate.
    MeSH term(s) Algorithms ; Artifacts ; Atrial Fibrillation/diagnosis ; Diagnosis, Computer-Assisted/methods ; Humans ; Reproducibility of Results ; Sensitivity and Specificity ; Signal Processing, Computer-Assisted
    Language English
    Publishing date 2010-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 160429-6
    ISSN 1558-2531 ; 0018-9294
    ISSN (online) 1558-2531
    ISSN 0018-9294
    DOI 10.1109/TBME.2009.2037974
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  9. Article ; Online: Low-frequency oscillations of atrial fibrillation cycle length in goats: characterization and potentiation by class III antiarrhythmic almokalant.

    Santos, Paulo Eustáquio de Brito / Duytschaever, Mattias / Allessie, Maurits A

    Journal of electrocardiology

    2008  Volume 41, Issue 6, Page(s) 711–723

    Abstract: Background: In chronically fibrillating goats, low-frequency oscillations (LFOs) of atrial fibrillation cycle length (AFCL) with a deceleration-acceleration sequence have been observed. The present investigation characterized such oscillations in ... ...

    Abstract Background: In chronically fibrillating goats, low-frequency oscillations (LFOs) of atrial fibrillation cycle length (AFCL) with a deceleration-acceleration sequence have been observed. The present investigation characterized such oscillations in control conditions and during the infusion of class III antiarrhythmic almokalant, trying to understand their mechanism and possible relevance.
    Methods and results: The study was performed on fibrillating goats instrumented with multiple electrodes. LFOs were characterized in 64-s recording samples (1 electrode/atrium) before and during almokalant infusion. Filtering was applied to the raw sequence of AFCL. LFOs were completely random, non-flutterlike and potentiated by almokalant, as evinced by increases in oscillation frequency, duration and amplitude. As compared with nonoscillation periods, the upper part of LFOs displayed an increase in single (84.0 +/- 11.4% vs 72.5 +/- 12.9%) and a reduction in double spikes (12.1 +/- 8.3% vs 20.2 +/- 8.6%), suggesting an improvement of propagation. This was supported by the features of activation maps during LFOs: fast conduction, few wave fronts and many linking beats.
    Conclusions: Chronically fibrillating goats exhibit random LFOs, which are enhanced by almokalant. The improvement of propagation during oscillations suggests an increase in the excitable period/excitable gap. These findings raise the question of LFOs involvement in atrial fibrillation termination.
    MeSH term(s) Animals ; Anti-Arrhythmia Agents/administration & dosage ; Atrial Fibrillation/chemically induced ; Atrial Fibrillation/physiopathology ; Biological Clocks ; Computer Simulation ; Electrocardiography/drug effects ; Female ; Goats ; Models, Cardiovascular ; Propanolamines
    Chemical Substances Anti-Arrhythmia Agents ; Propanolamines ; almokalant (I9NG89L275)
    Language English
    Publishing date 2008-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 410286-1
    ISSN 1532-8430 ; 0022-0736
    ISSN (online) 1532-8430
    ISSN 0022-0736
    DOI 10.1016/j.jelectrocard.2008.03.006
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  10. Article: Processing of intracardiac electrograms in atrial fibrillation. Diagnosis of electropathological substrate of AF.

    Houben, Richard P M / Allessie, Maurits A

    IEEE engineering in medicine and biology magazine : the quarterly magazine of the Engineering in Medicine & Biology Society

    2006  Volume 25, Issue 6, Page(s) 40–51

    MeSH term(s) Atrial Fibrillation/diagnosis ; Atrial Fibrillation/mortality ; Atrial Fibrillation/physiopathology ; Atrial Fibrillation/therapy ; Electrophysiologic Techniques, Cardiac ; Electrophysiology ; Heart Conduction System/physiopathology ; Humans ; Pulmonary Veins/physiopathology
    Language English
    Publishing date 2006-11-15
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 165249-7
    ISSN 1937-4186 ; 0739-5175 ; 0278-0054
    ISSN (online) 1937-4186
    ISSN 0739-5175 ; 0278-0054
    DOI 10.1109/emb-m.2006.250507
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