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. Author manuscript; available in PMC: 2022 Feb 1.
Published in final edited form as: J Mol Cell Cardiol. 2020 Oct 29;151:56–71. doi: 10.1016/j.yjmcc.2020.10.012

Figure 4. Human AF mapping and evolution of AF mechanisms.

Figure 4.

A. In-vivo epicardial and endocardial mapping visualized different mechanisms of AF maintenance. Adapted from Cox et al.,1991 [165]; Alessie et al., 2014 [170]; Narayan et al., 2013 [169]. B. Dual sided ex-vivo NIOM integrated with clinical multielectrode mapping (MEM) to validate clinical mapping methods and reveal AF driver mechanism. NIOM resolves intramural reentry, which is seen as multiple breakthroughs by clinical epicardial MEM. AF driver denoted by white arrow on Endo view, while star denotes breakthrough visualization on Epi view. Adapted from Hansen et al., 2015, 2018 [77, 83]; Li et al. 2016 [57]. C. Left, progressive electrophysiological and structural remodeling governs AF mechanism. Right, graph showing that the number of AF drivers may depend on the severity of fibrotic remodeling. Abbreviations: Epi – epicardial, Endo – endocardial; AF –atrial fibrillation; FIRM – focal impulse and rotor mapping; MEM – multielectrode mapping; MV – mitral valve; TV – tricuspid valve; LAA/RAA – left and right atrial appendages; NIOM – near-infrared optical mapping; pAF/perAF/LS-perAF – paroxysmal/ persistent AF/long-standing persistent AF; IVC/SVC – inferior and superior vena cava.