Focal activation patterns: breaking new grounds in the pathophysiology of atrial fibrillation

ABSTRACT

Introduction: High-resolution atrial mapping studies have provided novel insights in the pathophysiology of atrial fibrillation (AF) in the last few years. Increasing attention is being drawn to the so-called focal activation patterns (FAPs); however, there is no consensus on criteria to identify and characterize these patterns.

Areas covered: In this expert review, an overview of definitions and criteria used to examine FAPs obtained from atrial mapping studies is provided and studies reporting on the underlying mechanisms are discussed.

Expert commentary: High-resolution cardiac mapping has revealed the importance of FAPs in the pathophysiology of AF. There is increasing evidence supporting the concept of endo-epicardial (E-E) asynchrony enabling transmural conduction of electrical waves resulting in FAPs. Uniform reports of FAPs in future studies are needed to provide more knowledge on its clinical importance.

KEYWORDS:

• Atrial fibrillation
• atrial remodeling
• cardiac surgery
• electropathology
• electrophysiology
• epicardial mapping

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

NMS de Groot is supported by grants from the Dutch Heart Foundation (2012T0046), LSH-Impulse grant (40-43100-98-008), CVON AFFIP (914728) and VIDI grant (no.91717339).