Figure 6.
Effect of ablation and antiarrhythmic drugs on effective conducting size. Computational modeling confirmed that a critical LAECS > 4 cm was required for sustained multiple wavelet re‐entry. A, Re‐entry was sustained with LAECS = 6.18 cm (hexagon in “D”). B, Effect of reducing the atrial area to 80 cm2 (top row, continued AF, LAECS = 4.5 cm, closed circle in D) and 70 cm2 (bottom row, AF termination, LAECS = 3.94 cm, open circle in D). C, Effect of increasing sotalol doses on LAECS. AF continued when LAECS > 4 cm (top row, closed triangle in D) but terminated with LAECS = 4.0 cm (bottom row, open triangle in D). D, Illustrates how ablation or antiarrhythmic drugs could be applied to alter LAECS and remove patients from the region of vulnerability (shaded grey). Ablation would reduce left atrial body area with a corresponding reduction in LAECS (red arrow). Conversely, antiarrhythmic drugs to prolong refractoriness could be applied to increase LA wavelength (green arrow) and decrease LAECS. AF, atrial fibrillation; LAECS , LA effective conducting size