1
|
Park JI, Park SW, Kwon MJ, Lee J, Kim HJ, Lee CH, Shin DG. Surface ECG-based complexity parameters for predicting outcomes of catheter ablation for nonparoxysmal atrial fibrillation: efficacy of fibrillatory wave amplitude. Medicine (Baltimore) 2022; 101:e29949. [PMID: 35945788 PMCID: PMC9351908 DOI: 10.1097/md.0000000000029949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Catheter ablation (CA) is a well-established therapy for rhythm control in atrial fibrillation (AF). However, CA outcomes for persistent AF remain unsatisfactory because of the high recurrence rate despite time-consuming efforts and the latest ablation technology. Therefore, the selection of good responders to CA is necessary. Surface electrocardiography (sECG)-based complexity parameters were tested for the predictive ability of procedural termination failure during CA and late recurrence of atrial arrhythmias (AA) after CA. A total of 130 patients with nonparoxysmal AF who underwent CA for the first time were investigated. A 10-second sECG of 4 leads (leads I, II, V1, and V6) was analyzed to compute the fibrillatory wave amplitude (FWA), dominant frequency (DF), spectral entropy (SE), organization index (OI), and sample entropy (SampEn). The study endpoints were procedural termination failure during CA and late (≥1 year) AA recurrence after CA. In the multivariate analysis, FWA in lead V1 and DF in lead I were independent predictors of successful AF termination during CA (P <.05). The optimal cut-off values for FWA in lead V1 and DF in lead I were 60.38 μV (area under the curve [AUC], 0.672; P = .001) and 5.7 Hz (AUC, 0.630; P = .016), respectively. The combination of FWA of lead V1 and DF of lead I had a more powerful odds ratio for predicting procedural termination failure (OR, 8.542; 95% CI, 2.938-28.834; P < .001). FWA in lead V1 was the only independent predictor of late recurrence after CA. The cut-off value is 65.73 μV which was 0.634 of the AUC (P = .009). These sECG parameters, FWA in lead V1 and DF in lead I, predicted AF termination by CA in patients with nonparoxysmal AF. In particular, FWA in lead V1 was an independent predictor of late recurrence of AA after CA.
Collapse
Affiliation(s)
- Jong-Il Park
- Yeungnam University College of Medicine, Daegu, Korea
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | | | - Min-Ji Kwon
- Yeungnam University College of Medicine, Daegu, Korea
| | - Jeon Lee
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hong-Ju Kim
- Yeungnam University College of Medicine, Daegu, Korea
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Chan-Hee Lee
- Yeungnam University College of Medicine, Daegu, Korea
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Dong-Gu Shin
- Yeungnam University College of Medicine, Daegu, Korea
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
- *Correspondence: Dong-Gu Shin, Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea (e-mail: )
| |
Collapse
|
2
|
Zink MD, Laureanti R, Hermans BJM, Pison L, Verheule S, Philippens S, Pluymaekers N, Vroomen M, Hermans A, van Hunnik A, Crijns HJGM, Vernooy K, Linz D, Mainardi L, Auricchio A, Zeemering S, Schotten U. Extended ECG Improves Classification of Paroxysmal and Persistent Atrial Fibrillation Based on P- and f-Waves. Front Physiol 2022; 13:779826. [PMID: 35309059 PMCID: PMC8931504 DOI: 10.3389/fphys.2022.779826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
Background The standard 12-lead ECG has been shown to be of value in characterizing atrial conduction properties. The added value of extended ECG recordings (longer recordings from more sites) has not been systematically explored yet. Objective The aim of this study is to employ an extended ECG to identify characteristics of atrial electrical activity related to paroxysmal vs. persistent atrial fibrillation (AF). Methods In 247 participants scheduled for AF ablation, an extended ECG was recorded (12 standard plus 3 additional leads, 5 min recording, no filtering). For patients presenting in sinus rhythm (SR), the signal-averaged P-wave and the spatiotemporal P-wave variability was analyzed. For patients presenting in AF, f-wave properties in the QRST (the amplitude complex of the ventricular electrical activity: Q-, R-, S-, and T-wave)-canceled ECG were determined. Results Significant differences between paroxysmal (N = 152) and persistent patients with AF (N = 95) were found in several P-wave and f-wave parameters, including parameters that can only be calculated from an extended ECG. Furthermore, a moderate, but significant correlation was found between echocardiographic parameters and P-wave and f-wave parameters. There was a moderate correlation of left atrial (LA) diameter with P-wave energy duration (r = 0.317, p < 0.001) and f-wave amplitude in lead A3 (r = -0.389, p = 0.002). The AF-type classification performance significantly improved when parameters calculated from the extended ECG were taken into account [area under the curve (AUC) = 0.58, interquartile range (IQR) 0.50-0.64 for standard ECG parameters only vs. AUC = 0.76, IQR 0.70-0.80 for extended ECG parameters, p < 0.001]. Conclusion The P- and f-wave analysis of extended ECG configurations identified specific ECG features allowing improved classification of paroxysmal vs. persistent AF. The extended ECG significantly improved AF-type classification in our analyzed data as compared to a standard 10-s 12-lead ECG. Whether this can result in a better clinical AF type classification warrants further prospective study.
Collapse
Affiliation(s)
- Matthias Daniel Zink
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology and Vascular Medicine, Aachen, Germany
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Rita Laureanti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Center for Computational Modeling in Cardiology, Lugano, Switzerland
| | - Ben J. M. Hermans
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Laurent Pison
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- Ziekenhuis Oost Limburg, Genk, Belgium
| | - Sander Verheule
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Suzanne Philippens
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Nikki Pluymaekers
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Mindy Vroomen
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Astrid Hermans
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Arne van Hunnik
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Harry J. G. M. Crijns
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Dominik Linz
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Luca Mainardi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Angelo Auricchio
- Center for Computational Modeling in Cardiology, Lugano, Switzerland
- Instituto Cardiocentro Ticino, Lugano, Switzerland
| | - Stef Zeemering
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Ulrich Schotten
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| |
Collapse
|
3
|
Cycle Length Evaluation in Persistent Atrial Fibrillation Using Kernel Density Estimation to Identify Transient and Stable Rapid Atrial Activity. Cardiovasc Eng Technol 2021; 13:219-233. [PMID: 34453278 PMCID: PMC9114079 DOI: 10.1007/s13239-021-00568-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Abstract
Purpose Left atrial (LA) rapid AF activity has been shown to co-localise with areas of successful atrial fibrillation termination by catheter ablation. We describe a technique that identifies rapid and regular activity. Methods Eight-second AF electrograms were recorded from LA regions during ablation for psAF. Local activation was annotated manually on bipolar signals and where these were of poor quality, we inspected unipolar signals. Dominant cycle length (DCL) was calculated from annotation pairs representing a single activation interval, using a probability density function (PDF) with kernel density estimation. Cumulative annotation duration compared to total segment length defined electrogram quality. DCL results were compared to dominant frequency (DF) and averaging. Results In total 507 8 s AF segments were analysed from 7 patients. Spearman’s correlation coefficient was 0.758 between independent annotators (P < 0.001), 0.837–0.94 between 8 s and ≥ 4 s segments (P < 0.001), 0.541 between DCL and DF (P < 0.001), and 0.79 between DCL and averaging (P < 0.001). Poorer segment organization gave greater errors between DCL and DF. Conclusion DCL identifies rapid atrial activity that may represent psAF drivers. This study uses DCL as a tool to evaluate the dynamic, patient specific properties of psAF by identifying rapid and regular activity. If automated, this technique could rapidly identify areas for ablation in psAF.
Collapse
|
4
|
Pedrón-Torrecilla J, Rodrigo M, Climent AM, Liberos A, Pérez-David E, Bermejo J, Arenal Á, Millet J, Fernández-Avilés F, Berenfeld O, Atienza F, Guillem MS. Noninvasive Estimation of Epicardial Dominant High-Frequency Regions During Atrial Fibrillation. J Cardiovasc Electrophysiol 2016; 27:435-42. [PMID: 26776725 DOI: 10.1111/jce.12931] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 12/02/2015] [Accepted: 12/11/2015] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Ablation of high dominant frequency (DF) sources in patients with atrial fibrillation (AF) is an effective treatment option for paroxysmal AF. The aim of this study was to evaluate the accuracy of noninvasive estimation of DF and electrical patterns determination by solving the inverse problem of the electrocardiography. METHODS Four representative AF patients with left-to-right and right-to-left atrial DF patterns were included in the study. For each patient, intracardiac electrograms from both atria were recorded simultaneously together with 67-lead body surface recordings. In addition to clinical recordings, realistic mathematical models of atria and torso anatomy with different DF patterns of AF were used. For both mathematical models and clinical recordings, inverse-computed electrograms were compared to intracardiac electrograms in terms of voltage, phase, and frequency spectrum relative errors. RESULTS Comparison between intracardiac and inverse computed electrograms for AF patients showed 8.8 ± 4.4% errors for DF, 32 ± 4% for voltage, and 65 ± 4% for phase determination. These results were corroborated by mathematical simulations showing that the inverse problem solution was able to reconstruct the frequency spectrum and the DF maps with relative errors of 5.5 ± 4.1%, whereas the reconstruction of the electrograms or the instantaneous phase presented larger relative errors (i.e., 38 ± 15% and 48 ± 14 % respectively, P < 0.01). CONCLUSIONS Noninvasive reconstruction of atrial frequency maps can be achieved by solving the inverse problem of electrocardiography with a higher accuracy than temporal distribution patterns.
Collapse
Affiliation(s)
| | - Miguel Rodrigo
- ITACA, Universitat Politècnica de València, Valencia, Spain
| | - Andreu M Climent
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain and Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | | | - Esther Pérez-David
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain and Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - Javier Bermejo
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain and Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - Ángel Arenal
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain and Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - José Millet
- ITACA, Universitat Politècnica de València, Valencia, Spain
| | - Francisco Fernández-Avilés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain and Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - Omer Berenfeld
- Facultad de Medicina, Universidad Complutense de Madrid, Spain Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Felipe Atienza
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain and Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | | |
Collapse
|
5
|
Beltran-Molina FA, Cruz-Salazar E, Requena-Carrion J. Dependence of cardiac spectrum on the spatial resolution of the electrode systems in a realistic model of the canine ventricles. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:2223-6. [PMID: 26736733 DOI: 10.1109/embc.2015.7318833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Body-surface dominant frequency (DF) mapping has been proposed as a technique for non-invasively identifying high-frequency cardiac sources during fibrillation. However, previous studies indicate that volume conduction could distort the spectrum of body-surface cardiac signals and hence, affect body-surface DF maps. In this study, we analyze the effects of volume conduction on the spectrum of cardiac signals in a realistic computer model of the canine ventricles. We simulate complex cardiac dynamics on the ventricular model and analyze the dependence of the bandwidth (BW) of simulated unipolar cardiac signals on the spatial resolution of the corresponding unipolar electrode, which we quantify with the lead equivalent volume (LEV). Our analysis shows that the BW decreases for increasing LEV values and saturates for high LEV values. Our results also indicate that the LEV saturation value is low for low degrees of spatiotemporal correlation. We conclude that the spectral effects of volume conduction might limit our ability to accurately identify high-frequency sources in body-surface DF maps during cardiac fibrillation.
Collapse
|
6
|
Syed FF, Oral H. Electrophysiological Perspectives on Hybrid Ablation of Atrial Fibrillation. J Atr Fibrillation 2015; 8:1290. [PMID: 27957227 DOI: 10.4022/jafib.1290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/05/2015] [Accepted: 12/14/2015] [Indexed: 12/14/2022]
Abstract
To overcome limitations of minimally invasive surgical ablation as a standalone procedure in eliminating atrial fibrillation (AF), hybrid approaches incorporating adjunctive endovascular catheter ablation have been proposed in recent years. The endovascular component targets residual conduction gaps and identifies additional electrophysiological targets with the goal of minimizing recurrent atrial arrhythmia. We performed a systematic review of published studies of hybrid AF ablation, analyzing 432 pooled patients (19% paroxysmal, 29% persistent, 52% long-standing persistent) treated using three different approaches: A. bilateral thoracoscopy with bipolar radiofrequency (RF) clamp-based approach; B. right thoracoscopic suction monopolar RF catheter-based approach; and C. subxiphoid posterior pericardioscopic ("convergent") approach. Freedom from recurrence off antiarrhythmic medications at 12 months was seen in 88.1% [133/151] for A, 73.4% [47/64] for B, and 59.3% [80/135] for C, with no significant difference between paroxysmal (76.9%) and persistent/long-standing persistent AF (73.4%). Death and major surgical complications were reported in 8.5% with A, 0% with B and 8.6% with C. A critical appraisal of hybrid ablation is presented, drawing from experiences and insights published over the years on catheter ablation of AF, with a discussion of the rationale underlying hybrid ablation, its strengths and limitations, where it may have a unique role in clinical management of patients with AF, which questions remain unanswered and areas for further investigation.
Collapse
Affiliation(s)
- Faisal F Syed
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI
| | - Hakan Oral
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI
| |
Collapse
|
7
|
Wan E, Abrams J, Weinberg RL, Katchman AN, Bayne J, Zakharov SI, Yang L, Morrow JP, Garan H, Marx SO. Aberrant sodium influx causes cardiomyopathy and atrial fibrillation in mice. J Clin Invest 2015; 126:112-22. [PMID: 26595809 DOI: 10.1172/jci84669] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/15/2015] [Indexed: 01/17/2023] Open
Abstract
Increased sodium influx via incomplete inactivation of the major cardiac sodium channel Na(V)1.5 is correlated with an increased incidence of atrial fibrillation (AF) in humans. Here, we sought to determine whether increased sodium entry is sufficient to cause the structural and electrophysiological perturbations that are required to initiate and sustain AF. We used mice expressing a human Na(V)1.5 variant with a mutation in the anesthetic-binding site (F1759A-Na(V)1.5) and demonstrated that incomplete Na+ channel inactivation is sufficient to drive structural alterations, including atrial and ventricular enlargement, myofibril disarray, fibrosis and mitochondrial injury, and electrophysiological dysfunctions that together lead to spontaneous and prolonged episodes of AF in these mice. Using this model, we determined that the increase in a persistent sodium current causes heterogeneously prolonged action potential duration and rotors, as well as wave and wavelets in the atria, and thereby mimics mechanistic theories that have been proposed for AF in humans. Acute inhibition of the sodium-calcium exchanger, which targets the downstream effects of enhanced sodium entry, markedly reduced the burden of AF and ventricular arrhythmias in this model, suggesting a potential therapeutic approach for AF. Together, our results indicate that these mice will be important for assessing the cellular mechanisms and potential effectiveness of antiarrhythmic therapies.
Collapse
|
8
|
Gordon D, Goldberger JJ, Arora R, Aistrup GL, Ng J. Searching for "order" in atrial fibrillation using electrogram morphology recurrence plots. Comput Biol Med 2015; 65:220-8. [PMID: 26255963 DOI: 10.1016/j.compbiomed.2015.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/01/2015] [Accepted: 07/20/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bipolar electrograms recorded during atrial fibrillation (AF) can have an appearance of chaotic/random behavior. The aim of this study was to use a novel electrogram morphology recurrence (EMR) analysis to quantify the level of order in the morphology patterns in AF. METHODS Rapid atrial pacing was performed in seven dogs at 600bpm for 3 weeks leading to sustained AF. Open chest high density electrical recordings were made in multiple atrial sites. EMR plots of bipolar electrograms at each site were created by cross-correlating morphologies of each detected activations with morphologies of every other activation. The following features of the EMR plots were quantified: recurrence rate (RR), determinism (DET), laminarity (LAM), average diagonal line length (L), trapping time (TT), divergence (DIV), and Shannon׳s entropy (ENTR). For each recording site, these measures were calculated for the normal sequence of morphologies and also after random shuffling of the electrogram orders. RESULTS Electrograms recordings from a total of 3961 sites had average cycle lengths of 104±22ms resulting in an average of 100±19 activations detected per 10-s recording and an average RR of 0.38±0.28 (range 0.02-1.00). Shuffling the order of the activation morphologies resulted in significant decreases in DET, LAM, L, TT, and ENTR and significant increases in DIV. CONCLUSIONS EMR plots of AF electrograms show varying rates of recurrence with patterns that suggest an underlying deterministic structure to the activation sequences. A better understanding of AF dynamics could lead to improved methods in mapping and treating AF.
Collapse
Affiliation(s)
- David Gordon
- Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Jeffrey J Goldberger
- Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Rishi Arora
- Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Gary L Aistrup
- Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Jason Ng
- Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| |
Collapse
|
9
|
Costet A, Bunting E, Grondin J, Gambhir A, Konofagou EE. Atrial electromechanical cycle length mapping in paced canine hearts in vivo. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2015; 62:1277-87. [PMID: 26168174 PMCID: PMC4651183 DOI: 10.1109/tuffc.2014.006932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Atrial arrhythmias affect millions of people worldwide. Characterization and study of arrhythmias in the atria in the clinic is currently performed point by point using mapping catheters capable of generating maps of the electrical activation rate or cycle length. In this paper, we describe a new ultrasound-based mapping technique called electromechanical cycle length mapping (ECLM) capable of estimating the electromechanical activation rate, or cycle length, i.e., the rate of the mechanical activation of the myocardium which follows the electrical activation. ECLM relies on frequency analysis of the incremental strain within the atria and can be performed in a single acquisition. ECLM was validated in a canine model paced from the left atrial appendage, against pacing rates within the reported range of cycle lengths previously measured during atrial arrhythmias such as atrial fibrillation. Correlation between the global estimated electromechanical cycle lengths and pacing rates was shown to be excellent (slope = 0.983, intercept = 3.91, r(2) = 0.9999). The effect of the number of cardiac cycles on the performance of ECLM was also investigated and the reproducibility of ECLM was demonstrated (error between consecutive acquisitions for all pacing rates: 6.3 ± 4.3%). These findings indicate the potential of ECLM for noninvasively characterizing atrial arrhythmias and provide feedback on the treatment planning of catheter ablation procedures in the clinic.
Collapse
|
10
|
Yoshida K, Ogata K, Inaba T, Nakazawa Y, Ito Y, Yamaguchi I, Kandori A, Aonuma K. Ability of magnetocardiography to detect regional dominant frequencies of atrial fibrillation. J Arrhythm 2015; 31:345-51. [PMID: 26702313 PMCID: PMC4672036 DOI: 10.1016/j.joa.2015.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/05/2015] [Accepted: 05/11/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Lead V1 on electrocardiography (ECG) can detect the dominant frequency (DF) of atrial fibrillation (AF) in the right atrium (RA). Paroxysmal AF is characterized by a frequency gradient from the left atrium (LA) to the right atrium (RA). We examined the ability of magnetocardiography (MCG) to detect regional DFs in both the atria. METHODS Study subjects comprised 18 consecutive patients referred for catheter ablation of persistent AF. An MCG system with 64 magnetic sensors was used to perform MCG in the frontal, lateral, and back planes prior to the ablation procedure in each patient. DFMCG and organization index (OIMCG) were calculated using fast Fourier transformation. Intracardiac electrograms (ICEs) in both the atria and the coronary sinus (CS) were mapped at 17 sites. Regional DFsICE were also determined. RESULTS Mean LA DFICE was higher than mean RA DFICE (6.40±0.66 versus 6.16±0.80 Hz, P=0.03). DFMCG in the channel having the highest OIMCG was 6.61±0.88 Hz in the frontal plane, 6.52±0.64 Hz in the lateral plane, and 6.42±0.62 Hz in the back plane (P=0.3). In each plane, DFMCG correlated with DFICE at the RA appendage (R=0.95, P<0.0001), the LA appendage (R=0.91, P<0.0001), and the CS (R=0.93, P<0.0001). DFECG in V5 modestly correlated with DFICE at the LA appendage (R=0.82, P<0.0001). CONCLUSIONS MCG could more precisely detect the DFs in the LA and the CS than ECG. However, the usefulness of pre-procedural detection of the AF frequency gradient for ablation therapy needs to be evaluated in future prospective studies.
Collapse
Affiliation(s)
- Kentaro Yoshida
- Division of Cardiovascular Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kuniomi Ogata
- Advanced Research Laboratory, Hitachi Ltd., Kokubunji, Japan
| | - Takeshi Inaba
- Division of Cardiovascular Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoko Nakazawa
- Division of Cardiovascular Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoko Ito
- Division of Cardiovascular Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Akihiko Kandori
- Advanced Research Laboratory, Hitachi Ltd., Kokubunji, Japan
| | - Kazutaka Aonuma
- Division of Cardiovascular Medicine, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
11
|
Bojarnejad M, Blake JR, Bourke J, Shepherd E, Murray A, Langley P. Non-Invasive Estimation Of Left Atrial Dominant Frequency In Atrial Fibrillation From Different Electrode Sites: Insight From Body Surface Potential Mapping. J Atr Fibrillation 2014; 7:1131. [PMID: 27957121 DOI: 10.4022/jafib.1131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 08/13/2014] [Accepted: 09/03/2014] [Indexed: 12/16/2022]
Abstract
The dominant driving sources of atrial fibrillation are often found in the left atrium, but the expression of left atrial activation on the body surface is poorly understood. Using body surface potential mapping and simultaneous invasive measurements of left atrial activation our aim was to describe the expression of the left atrial dominant fibrillation frequency across the body surface. 20 patients in atrial fibrillation were studied. The spatial distributions of the dominant atrial fibrillation frequency across anterior and posterior sites on the body surface were quantified. Their relationship with invasive left atrial dominant fibrillation frequency was assessed by linear regression analysis, and the coefficient of determination was calculated for each body surface site. The correlation between intracardiac and body surface dominant frequency was significantly higher with posterior compared with anterior sites (coefficient of determination 67±8% vs 48±2%, p<0.001). The site with largest coefficient of determination was 79.6% (p<0.001) and was a posterior site. In comparison with the site closest to lead V1 it had a coefficient of determination of 23.0% (p=0.033), and with the posterior body surface site closest to lead V9 had a coefficient of determination of 70.3% (p<0.001). Left atrial dominant fibrillation frequency was more closely represented at posterior body surface sites.
Collapse
Affiliation(s)
- Marjan Bojarnejad
- Marjan Bojarnejad, Institute of Cellular Medicine, Newcastle University, Medical School, Newcastle upon Tyne, NE2 4HH. James R Blake, Regional Medical Physics Department, Royal Victoria Infirmary, Newcastle upon Tyne, NE4 1LP. John Bourke, Cardiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN. Ewan Shepherd, Cardiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN. Alan Murray, Institute of Cellular Medicine, Newcastle University, Medical School, Newcastle upon Tyne, NE2 4HH. Philip Langley, School of Engineering, University of Hull, Hull, HU6 7RX
| | - James R Blake
- Marjan Bojarnejad, Institute of Cellular Medicine, Newcastle University, Medical School, Newcastle upon Tyne, NE2 4HH. James R Blake, Regional Medical Physics Department, Royal Victoria Infirmary, Newcastle upon Tyne, NE4 1LP. John Bourke, Cardiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN. Ewan Shepherd, Cardiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN. Alan Murray, Institute of Cellular Medicine, Newcastle University, Medical School, Newcastle upon Tyne, NE2 4HH. Philip Langley, School of Engineering, University of Hull, Hull, HU6 7RX
| | - John Bourke
- Marjan Bojarnejad, Institute of Cellular Medicine, Newcastle University, Medical School, Newcastle upon Tyne, NE2 4HH. James R Blake, Regional Medical Physics Department, Royal Victoria Infirmary, Newcastle upon Tyne, NE4 1LP. John Bourke, Cardiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN. Ewan Shepherd, Cardiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN. Alan Murray, Institute of Cellular Medicine, Newcastle University, Medical School, Newcastle upon Tyne, NE2 4HH. Philip Langley, School of Engineering, University of Hull, Hull, HU6 7RX
| | - Ewan Shepherd
- Marjan Bojarnejad, Institute of Cellular Medicine, Newcastle University, Medical School, Newcastle upon Tyne, NE2 4HH. James R Blake, Regional Medical Physics Department, Royal Victoria Infirmary, Newcastle upon Tyne, NE4 1LP. John Bourke, Cardiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN. Ewan Shepherd, Cardiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN. Alan Murray, Institute of Cellular Medicine, Newcastle University, Medical School, Newcastle upon Tyne, NE2 4HH. Philip Langley, School of Engineering, University of Hull, Hull, HU6 7RX
| | - Alan Murray
- Marjan Bojarnejad, Institute of Cellular Medicine, Newcastle University, Medical School, Newcastle upon Tyne, NE2 4HH. James R Blake, Regional Medical Physics Department, Royal Victoria Infirmary, Newcastle upon Tyne, NE4 1LP. John Bourke, Cardiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN. Ewan Shepherd, Cardiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN. Alan Murray, Institute of Cellular Medicine, Newcastle University, Medical School, Newcastle upon Tyne, NE2 4HH. Philip Langley, School of Engineering, University of Hull, Hull, HU6 7RX
| | - Philip Langley
- Marjan Bojarnejad, Institute of Cellular Medicine, Newcastle University, Medical School, Newcastle upon Tyne, NE2 4HH. James R Blake, Regional Medical Physics Department, Royal Victoria Infirmary, Newcastle upon Tyne, NE4 1LP. John Bourke, Cardiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN. Ewan Shepherd, Cardiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN. Alan Murray, Institute of Cellular Medicine, Newcastle University, Medical School, Newcastle upon Tyne, NE2 4HH. Philip Langley, School of Engineering, University of Hull, Hull, HU6 7RX
| |
Collapse
|
12
|
Ravelli F, Masè M, Cristoforetti A, Marini M, Disertori M. The logical operator map identifies novel candidate markers for critical sites in patients with atrial fibrillation. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 115:186-97. [PMID: 25077410 DOI: 10.1016/j.pbiomolbio.2014.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/17/2014] [Indexed: 11/28/2022]
Abstract
The identification of suitable markers for critical patterns during atrial fibrillation (AF) may be crucial to guide an effective ablation treatment. Single parameter maps, based on dominant frequency and complex fractionated electrograms, have been proposed as a tool for electrogram-guided ablation, however the specificity of these markers is debated. Experimental studies suggest that AF critical patterns may be identified on the basis of specific rate and organization features, where rapid organized and rapid fragmented activities characterize respectively localized sources and critical substrates. In this paper we introduce the logical operator map, a novel mapping tool for a point-by-point identification and localization of AF critical sites. Based on advanced signal and image processing techniques, the approach combines in a single map electrogram-derived rate and organization features with tomographic anatomical detail. The construction of the anatomically-detailed logical operator map is based on the time-domain estimation of atrial rate and organization in terms of cycle length and wave-similarity, the logical combination of these indexes to obtain suitable markers of critical sites, and the multimodal integration of electrophysiological and anatomical information by segmentation and registration techniques. Logical operator maps were constructed in 14 patients with persistent AF, showing the capability of the combined rate and organization markers to identify with high selectivity the subset of electrograms associated with localized sources and critical substrates. The precise anatomical localization of these critical sites revealed the confinement of rapid organized sources in the left atrium with organization and rate gradients towards the surrounding tissue, and the presence of rapid fragmented electrograms in proximity of the sources. By merging in a single map the most relevant electrophysiological and anatomical features of the AF process, the logical operator map may have significant clinical impact as a direct, comprehensive tool to understand arrhythmia mechanisms in the single patient and guide more conservative, step-wise ablation.
Collapse
Affiliation(s)
- Flavia Ravelli
- Department of Physics, University of Trento, Povo-Trento, Italy.
| | - Michela Masè
- Department of Physics, University of Trento, Povo-Trento, Italy
| | | | | | - Marcello Disertori
- Division of Cardiology, S. Chiara Hospital, Trento, Italy; Healthcare Research and Innovation Program, PAT-FBK, Trento, Italy
| |
Collapse
|
13
|
Ravelli F, Masè M. Computational mapping in atrial fibrillation: how the integration of signal-derived maps may guide the localization of critical sources. ACTA ACUST UNITED AC 2014; 16:714-23. [DOI: 10.1093/europace/eut376] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
14
|
Ng J, Sehgal V, Ng JK, Gordon D, Goldberger JJ. Iterative Method to Detect Atrial Activations and Measure Cycle Length From Electrograms During Atrial Fibrillation. IEEE Trans Biomed Eng 2014; 61:273-8. [DOI: 10.1109/tbme.2013.2290003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
15
|
Requena-Carrión J, Beltrán-Molina FA, Marques AG. Relating the spectrum of cardiac signals to the spatiotemporal dynamics of cardiac sources. Biomed Signal Process Control 2013. [DOI: 10.1016/j.bspc.2013.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
16
|
Traykov VB, Pap R, Saghy L. Frequency domain mapping of atrial fibrillation - methodology, experimental data and clinical implications. Curr Cardiol Rev 2013; 8:231-8. [PMID: 22935020 PMCID: PMC3465829 DOI: 10.2174/157340312803217229] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 06/07/2012] [Accepted: 06/28/2012] [Indexed: 11/26/2022] Open
Abstract
The concept of dominant frequency (DF) has been used as a way to express local atrial activation rate during atrial fibrillation (AF). The rotor theory explaining the pathophysiology of AF is widely based upon spatial distribution of DF in the atria. Using frequency domain analysis to represent the rate of atrial activation by DF can avoid some of the limitations of time domain analysis of signals during AF. Understanding the concept of DF is of utmost importance to the proper use and interpretation of frequency domain analysis in AF. The current review focuses on the basic principles and methodology of frequency domain analysis using the Fourier transform during different types of AF. It also provides an update of the published experimental and clinical data on frequency domain analysis in light of the rotor theory for AF maintenance.
Collapse
Affiliation(s)
- Vassil B Traykov
- Clinic of Cardiology and Angiology, Tokuda Hospital - Sofia, N.Vaptzarov blvd. 51B, 1407 Sofia, Bulgaria.
| | | | | |
Collapse
|
17
|
Jones AR, Krummen DE, Narayan SM. Non-invasive identification of stable rotors and focal sources for human atrial fibrillation: mechanistic classification of atrial fibrillation from the electrocardiogram. Europace 2013; 15:1249-58. [PMID: 23449925 DOI: 10.1093/europace/eut038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To develop electrocardiogram (ECG) tools to quantify the number of sources for atrial fibrillation (AF), i.e. spatially stable rotors and focal impulses, and whether they lie in right or left atrium. Intracardiac mapping has recently shown that paroxysmal and persistent AF is sustained by rotors or focal sources that are stable in location and thus targets for limited ablation [focal impulse and rotor modulation (FIRM)] to eliminate AF. Importantly, the numbers and locations of concurrent sources determine both the complexity of AF and the approach for ablation. METHODS AND RESULTS In 36 AF patients (n = 29 persistent, 63 ± 9 years) in the CONventional ablation with or without Focal Impulse and Rotor Modulation (CONFIRM) trial, we developed phase lock (PL) to quantify spatial repeatability of ECG 'F-waves' between leads over time. Phase lock spectrally quantifies the angle θ between F-wave voltages in planes formed by ECG leads I, aVF, and V1 at successive points in time. We compared PL with ECG spectral dominant frequency (DF) and organizational index (OI) to characterize stable rotors and focal sources validated by intracardiac FIRM mapping. Focal impulse and rotor modulation ablation alone at ≤3 sources acutely terminated and rendered AF non-inducible or substantially slowed AF in 31 of 36 patients. Receiver operating characteristics of PL for this endpoint had area under the curve (AUC) = 0.72, and the optimum cut-point (PL = 0.09) had 74% sensitivity, 92% positive predictive value (PPV). Receiver operating characteristics areas for OI and DF were 0.50 and 0.58, respectively. Left (n = 28) or right (n = 3) atrial sources were localized by PL with AUC = 0.85, sensitivity 100%, PPV 30%, and negative predictive value 100%. Spectral DF provided AUC = 0.79. Notably, PL did not comigrate with diagnosis of paroxysmal or persistent AF (P = NS), unlike ECG DF. CONCLUSION The novel metric of ECG PL identifies patients with fewer (≤3) or greater numbers of stable rotors/focal sources for AF, validated by intracardiac FIRM mapping, and localized them to right or left atria. These data open the possibility of using 12-lead ECG analyses to classify AF mechanistically and plan procedures for right- or left-sided FIRM ablation.
Collapse
Affiliation(s)
- Aled R Jones
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | | |
Collapse
|
18
|
Guillem MS, Climent AM, Millet J, Arenal Á, Fernández-Avilés F, Jalife J, Atienza F, Berenfeld O. Noninvasive localization of maximal frequency sites of atrial fibrillation by body surface potential mapping. Circ Arrhythm Electrophysiol 2013; 6:294-301. [PMID: 23443619 DOI: 10.1161/circep.112.000167] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ablation of high-frequency sources in patients with atrial fibrillation (AF) is an effective therapy to restore sinus rhythm. However, this strategy may be ineffective in patients without a significant dominant frequency (DF) gradient. The aim of this study was to investigate whether sites with high-frequency activity in human AF can be identified noninvasively, which should help intervention planning and therapy. METHODS AND RESULTS In 14 patients with a history of AF, 67-lead body surface recordings were simultaneously registered with 15 endocardial electrograms from both atria including the highest DF site, which was predetermined by atrial-wide real-time frequency electroanatomical mapping. Power spectra of surface leads and the body surface location of the highest DF site were compared with intracardiac information. Highest DFs found on specific sites of the torso showed a significant correlation with DFs found in the nearest atrium (ρ=0.96 for right atrium and ρ=0.92 for left atrium) and the DF gradient between them (ρ=0.93). The spatial distribution of power on the surface showed an inverse relationship between the frequencies versus the power spread area, consistent with localized fast sources as the AF mechanism with fibrillatory conduction elsewhere. CONCLUSIONS Spectral analysis of body surface recordings during AF allows a noninvasive characterization of the global distribution of the atrial DFs and the identification of the atrium with the highest frequency, opening the possibility for improved noninvasive personalized diagnosis and treatment.
Collapse
|
19
|
Grubitzsch H, Haverkamp W. Atrial Remodelling : Role in Atrial Fibrillation Ablation. J Atr Fibrillation 2012; 5:691. [PMID: 28496795 DOI: 10.4022/jafib.691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/02/2012] [Accepted: 11/23/2012] [Indexed: 12/19/2022]
Abstract
There have been considerable advances in understanding the relationship of atrial fibrillation (AF) and atrial remodelling suggesting that remodelling states have a significant impact on treatment results. Therefore, we reviewed the literature about the role of atrial remodelling in AF treatment, focussing on AF ablation. Atrial fibrillatory activity, dominant frequencies (DF), complex fractionated atrial electrograms (CFAE) as well as function, volume, and fibrosis of the - especially left - atrium are most important characteristics for electrical, contractile, and structural remodelling predicting success of AF treatment. In particular, the results of AF ablation, either using catheter-based or surgical techniques, predominantly depend on the degree of structural remodelling, namely dilatation and fibrosis of the left atrium. The available data suggest that recognizing parameters of remodelling as predictors for AF treatment facilitates differentiation between patients who may or may not benefit from the procedure and individualization of AF treatment by adapting lesion sets, by ablating additional targets, by reducing left atrial size, or by applying extended pharmacological treatment.
Collapse
Affiliation(s)
| | - Wilhelm Haverkamp
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité - Universit?tsmedizin Berlin, Berlin, Germany
| |
Collapse
|
20
|
Lee S, Ryu K, Waldo AL, Khrestian CM, Durand DM, Sahadevan J. An algorithm to measure beat-to-beat cycle lengths for assessment of atrial electrogram rate and regularity during atrial fibrillation. J Cardiovasc Electrophysiol 2012; 24:199-206. [PMID: 23140386 DOI: 10.1111/jce.12014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Experimental models have demonstrated that atrial fibrillation (AF) may be due to one or more rapid drivers (source) producing AF. These drivers may be characterized by rapid and regular cycle lengths (CLs), producing fibrillatory conduction to the rest of the atria. The ability to reliably identify such drivers would be invaluable. The purpose of this study was to develop and validate a CL variability detection (CLVD) analysis capable of accurately determining beat-to-beat CLs of atrial electrograms (AEGs) during AF, and then to compare this analysis with dominant frequency (DF) analysis. METHODS AND RESULTS We analyzed 6 episodes of AF in 6 dogs (sterile pericarditis model) due either to a single, stable left atrial reentrant circuit, or unstable reentrant circuits causing fibrillatory conduction to the rest of the atria. During AF, AEGs were recorded simultaneously from 400 to 420 electrodes on both atria. CLs from over 20,000 AEGs were manually measured, and compared to CLs detected using both the CLVD and DF analyses. There was significant correlation between (1) CLs measured manually and the CLVD analysis (mean CL: correlation coefficient [CC]= 0.96, standard deviation [SD]: CC = 0.89); and (2) mean CL measured manually and the DF analysis (CC = 0.84). However, there was poor correlation between SD of CLs measured manually and the organization index (OI) by DF analysis (CC =-0.59). CONCLUSION The CLVD analysis was validated as being accurate for detecting both rate and degree of regularity of AEGs during AF, and more accurate than DF analysis.
Collapse
Affiliation(s)
- Seungyup Lee
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | | |
Collapse
|
21
|
Atienza F, Martins RP, Jalife J. Translational research in atrial fibrillation: a quest for mechanistically based diagnosis and therapy. Circ Arrhythm Electrophysiol 2012; 5:1207-15. [PMID: 23022707 DOI: 10.1161/circep.111.970335] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Felipe Atienza
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | |
Collapse
|
22
|
Abstract
Therapy for atrial fibrillation (AF) remains suboptimal, in large part because its mechanisms are unclear. While pulmonary vein ectopy may trigger AF, it remains uncertain how AF, once triggered, is actually sustained. Recent discoveries show that human AF is maintained by a small number of rotors or focal sources. AF sources are widely distributed in patient-specific locations, often remote from pulmonary veins and in the right atrium and stable for prolonged periods of time. In a multicentre experience, brief targeted ablation at sources (focal impulse and rotor modulation [FIRM]) terminated AF predominantly to sinus rhythm prior to pulmonary vein isolation and eliminated AF on rigorous followup. This review summarises the evidence for stable rotors and focal sources of human AF and their clinical role as ablation targets to eliminate paroxysmal, persistent and long-standing persistent AF.
Collapse
Affiliation(s)
| | - David E Krummen
- Associate Professor of Medicine, University of California and Veterans' Affairs Medical Centers, San Diego, California
| |
Collapse
|
23
|
2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol 2012; 33:171-257. [PMID: 22382715 DOI: 10.1007/s10840-012-9672-7] [Citation(s) in RCA: 256] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.
Collapse
|
24
|
Jarman JWE, Wong T, Kojodjojo P, Spohr H, Davies JE, Roughton M, Francis DP, Kanagaratnam P, Markides V, Davies DW, Peters NS. Spatiotemporal behavior of high dominant frequency during paroxysmal and persistent atrial fibrillation in the human left atrium. Circ Arrhythm Electrophysiol 2012; 5:650-8. [PMID: 22722660 DOI: 10.1161/circep.111.967992] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sites of high dominant frequency (DF(peak)) are thought to indicate the location of drivers of atrial fibrillation (AF), but characterization of their spatiotemporal distribution and stability, critical to their relevance as targets for catheter ablation, requires simultaneous global mapping of the left atrium. METHODS AND RESULTS Noncontact electrograms recorded simultaneously from 256 left atrial sites during spontaneous AF were analyzed. After subtraction of the ventricular component, fast Fourier transform identified the DF at each site. Focal areas of DF(peak) were defined as those having a DF >20% above all neighboring sites. Twenty-four patients with spontaneous AF (11 paroxysmal and 13 persistent) were studied. In paroxysmal AF, sites of DF(peak) (mean DF, 11.6±2.9 Hz) were observed in 100% of patients (present during 65% of the mapping period). In contrast, DF(peak) was detected in only 31% of patients with persistent AF (P<0.001) and for only 5% of the mapping period (P<0.001). In both groups, locations of DF(peak) varied widely in both consecutive and separated segments of AF (κ coefficient range, -0.07-0.22). Activation sequences around sites of DF(peak) did not demonstrate centrifugal activation that would be expected from focal drivers. CONCLUSIONS Focal areas of high DF are more frequent in paroxysmal than persistent AF, are spatiotemporally unstable, are not the source of centrifugal activation, and are not, therefore, indicative of fixed drivers of AF. In the absence of spatiotemporal stability, the success of ablation at sites of DF(peak) cannot be explained by elimination of fixed drivers.
Collapse
Affiliation(s)
- Julian W E Jarman
- Department of Cardiology, St Mary's Hospital, and Myocardial Function, Imperial College, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJG, Damiano RJ, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 2012; 14:528-606. [PMID: 22389422 DOI: 10.1093/europace/eus027] [Citation(s) in RCA: 1141] [Impact Index Per Article: 95.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
|
26
|
Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJG, Damiano RJ, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm 2012; 9:632-696.e21. [PMID: 22386883 DOI: 10.1016/j.hrthm.2011.12.016] [Citation(s) in RCA: 1299] [Impact Index Per Article: 108.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Indexed: 12/20/2022]
|
27
|
VERMA ATUL, LAKKIREDDY DHANUNJAYA, WULFFHART ZAEV, PILLARISETTI JAYASREE, FARINA DOMENIC, BEARDSALL MARIANNE, WHALEY BONNIE, GIEWERCER DAVID, TSANG BERNICE, KHAYKIN YAARIV. Relationship Between Complex Fractionated Electrograms (CFE) and Dominant Frequency (DF) Sites and Prospective Assessment of Adding DF-Guided Ablation to Pulmonary Vein Isolation in Persistent Atrial Fibrillation (AF). J Cardiovasc Electrophysiol 2011; 22:1309-16. [DOI: 10.1111/j.1540-8167.2011.02128.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
Forclaz A, Narayan SM, Scherr D, Linton N, Jadidi AS, Nault I, Rivard L, Miyazaki S, Uldry L, Wright M, Shah AJ, Liu X, Xhaet O, Derval N, Knecht S, Sacher F, Jaïs P, Hocini M, Haïssaguerre M. Early temporal and spatial regularization of persistent atrial fibrillation predicts termination and arrhythmia-free outcome. Heart Rhythm 2011; 8:1374-82. [PMID: 21699850 DOI: 10.1016/j.hrthm.2011.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 05/09/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Termination of persistent atrial fibrillation (AF) is a valuable ablation endpoint but is difficult to anticipate. We evaluated whether temporal and spatial indices of AF regularization predict intraprocedural AF termination and outcome. OBJECTIVE The purpose of this study was to test whether temporospatial organization of AF after pulmonary vein isolation (PVI) predicts whether subsequent stepwise ablation will terminate persistent AF or predict outcome. METHODS In 75 patients with persistent AF, we measured AF cycle length (AFCL), temporal regularity index (TRI, a spectral measure of timing regularity), and spatial regularity index (SRI, cycle-to-cycle variations in spatial vector) between right atrial appendage and proximal and distal coronary sinus before and during stepwise ablation to the endpoint of AF termination. RESULTS AF termination was achieved in 59 patients (79%) by ablation. AF terminated during PVI in 11 patients, who were excluded from analysis. In the remaining 48 patients, TRI and SRI increased during stepwise ablation, as compared with 16 patients without termination (P<.05). AFCL was prolonged in both groups. From receiver operating characteristics analysis of the first 22 patients (training set), a post-PVI TRI increase predicted AF termination in the latter 42 patients (test set) with a positive predictive value of 96%, negative predictive value of 53%, sensitivity of 71%, and specificity of 91%. Results were similar for SRI. After 36 months, higher arrhythmia-free outcome was observed in patients in whom PVI caused temporospatial regularization in AF. CONCLUSIONS Temporal and spatial regularization of persistent AF after PVI identifies patients in whom stepwise ablation subsequently terminates AF and prevents recurrence.
Collapse
|
29
|
Romero I, Fleck E, Kriatselis C. Frequency analysis of atrial fibrillation surface and intracardiac electrograms during pulmonary vein isolation. Europace 2011; 13:1340-5. [PMID: 21486914 DOI: 10.1093/europace/eur104] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Frequency analysis of atrial electrograms from patients diagnosed with persistent atrial fibrillation (AF) appears to be crucial in its clinical diagnosis. This work explores the fibrillatory frequency properties of both surface and intracardiac electrograms before and after pulmonary vein isolation (PVI) using three time-frequency techniques. METHODS AND RESULTS Surface electrocardiograms (ECGs) of 21 patients diagnosed with persistent AF undergoing PVI were recorded. Three methods, Fourier, ensemble average, and wavelet analysis, were used to identify the dominant frequency (DF) in surface ECGs. Dominant frequency was also computed in electrograms recorded within the coronary sinus (CS). Dominant frequency measured within the CS was best estimated in surface lead V1 using both Fourier (relative error: 10.94 ± 10.37%, correlation: 0.58) and wavelet analysis (relative error: 10.97 ± 11.08%, correlation: 0.53). Ensemble average gave highest relative error (21.29 ± 18.07%) and lowest correlation (0.10). Dominant frequency decreased after right PVI. This decrease was significant (P< 0.05) in most of the patients (13, 14, and 7 out of 14 when Fourier, wavelets, and ensemble average was used; 14 in CS). Further isolation of the left pulmonary veins (PVs) yielded a significant (P< 0.05) decrease in only a few of them (3, 4, and 2 out of 14 when Fourier, wavelets, and ensemble average was used; 4 in CS). CONCLUSION Wavelet and Fourier analysis are good tools for estimating the atrial fibrillatory rate from surface ECG. A drop was observed in the DF value after isolation of the right PV. However, after left PVI this decrease was smaller.
Collapse
Affiliation(s)
- Iñaki Romero
- Physikalisch-Technische Bundesanstalt, Berlin, Germany.
| | | | | |
Collapse
|
30
|
Schotten U, Verheule S, Kirchhof P, Goette A. Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. Physiol Rev 2011; 91:265-325. [PMID: 21248168 DOI: 10.1152/physrev.00031.2009] [Citation(s) in RCA: 852] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Atrial fibrillation (AF) is an arrhythmia that can occur as the result of numerous different pathophysiological processes in the atria. Some aspects of the morphological and electrophysiological alterations promoting AF have been studied extensively in animal models. Atrial tachycardia or AF itself shortens atrial refractoriness and causes loss of atrial contractility. Aging, neurohumoral activation, and chronic atrial stretch due to structural heart disease activate a variety of signaling pathways leading to histological changes in the atria including myocyte hypertrophy, fibroblast proliferation, and complex alterations of the extracellular matrix including tissue fibrosis. These changes in electrical, contractile, and structural properties of the atria have been called "atrial remodeling." The resulting electrophysiological substrate is characterized by shortening of atrial refractoriness and reentrant wavelength or by local conduction heterogeneities caused by disruption of electrical interconnections between muscle bundles. Under these conditions, ectopic activity originating from the pulmonary veins or other sites is more likely to occur and to trigger longer episodes of AF. Many of these alterations also occur in patients with or at risk for AF, although the direct demonstration of these mechanisms is sometimes challenging. The diversity of etiological factors and electrophysiological mechanisms promoting AF in humans hampers the development of more effective therapy of AF. This review aims to give a translational overview on the biological basis of atrial remodeling and the proarrhythmic mechanisms involved in the fibrillation process. We pay attention to translation of pathophysiological insights gained from in vitro experiments and animal models to patients. Also, suggestions for future research objectives and therapeutical implications are discussed.
Collapse
Affiliation(s)
- Ulrich Schotten
- Department of Physiology, University Maastricht, Maastricht, The Netherlands.
| | | | | | | |
Collapse
|
31
|
Biviano AB, Coromilas J, Ciaccio EJ, Whang W, Hickey K, Garan H. Frequency domain and time complex analyses manifest low correlation and temporal variability when calculating activation rates in atrial fibrillation patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:540-8. [PMID: 21208232 DOI: 10.1111/j.1540-8159.2010.02993.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) activation rates have been calculated using both frequency domain and time complex analyses. Direct comparisons of these methods are limited. We report: (1) their correlation when measuring AF activation rates, (2) comparisons of recording durations required to minimize variability, and (3) differences in the temporal reproducibility. METHODS AF activation rates were calculated using domain frequency (DF) (via fast Fourier transform) and time complex (TC) (via beat-to-beat activation measurements) analyses. We compared: (1) AF frequencies derived from each method; (2) successively longer subinterval durations to their 16-second reference intervals, and (3) the correlation between consecutively collected 8-second segments and segments collected 10 minutes apart. RESULTS There was low intraclass correlation coefficient (ICC = 0.234) when comparing AF activation rates derived using DF versus TC analysis. There was no difference in the frequencies between any of the subintervals compared to their 16-second reference intervals, but variability of measurements was higher for intervals <8 seconds (P < 0.01). Correlations between successive segments and segments taken 10 minutes apart were 0.92 and 0.75 using DF analysis (P < 0.001), and 0.72 and 0.49 using TC analysis (P < 0.001). CONCLUSIONS There is low correlation between the DF and TC methods of analyzing AF activation rates. While AF rates do not differ between subintervals and 16-second reference electrograms, the variability of measurements is dependent upon the subinterval duration, and increases for durations less than 8 seconds. AF rates were prone to change over a 10-minute time period. These results point out existing clinical limitations of measuring atrial activation rates in AF patients.
Collapse
Affiliation(s)
- Angelo B Biviano
- Cardiology Division, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.
| | | | | | | | | | | |
Collapse
|
32
|
Abstract
This brief review looks back to the major theoretical, experimental, and clinical work on the dynamics and mechanisms of atrial fibrillation (AF). Its goal is to highlight the most important issues, controversies, and advances that have driven the field of investigation into AF mechanisms at any given time during the last ∼100 years. It emphasizes that while the history of AF research has been full of controversies from the start, such controversies have led to new information, and individual scientists have learned from those that have preceded them. However, in the face of the most common sustained cardiac arrhythmia seen in clinical practice, we are yet to fully understand its fundamental mechanisms and learn how to treat it effectively. Future research into AF dynamics and mechanisms should focus on the development and validation of new numerical and animal models. Such models should be relevant to and accurately reproduce the important substrates associated with ageing and with diseases such as hypertension, heart failure, and ischaemic heart disease which cause AF in the vast majority of patients. Knowledge derived from such models may help to greatly advance the field and hopefully lead to more effective prevention and therapy.
Collapse
Affiliation(s)
- José Jalife
- Department of Internal Medicine/Cardiovascular Medicine, Center for Arrhythmia Research, University of Michigan, 5022 Venture Drive, Ann Arbor, MI 40108, USA.
| |
Collapse
|
33
|
Elayi CS, Di Biase L, Barrett C, Ching CK, Aly MA, Lucciola M, Bai R, Horton R, Fahmy TS, Verma A, Khaykin Y, Shah J, Morales G, Hongo R, Hao S, Beheiry S, Arruda M, Schweikert RA, Cummings J, Burkhardt JD, Wang P, Al-Ahmad A, Cauchemez B, Gaita F, Natale A. Atrial fibrillation termination as a procedural endpoint during ablation in long-standing persistent atrial fibrillation. Heart Rhythm 2010; 7:1216-23. [DOI: 10.1016/j.hrthm.2010.01.038] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 01/26/2010] [Indexed: 11/28/2022]
|
34
|
Toward discerning the mechanisms of atrial fibrillation from surface electrocardiogram and spectral analysis. J Electrocardiol 2010; 43:509-14. [PMID: 20673913 DOI: 10.1016/j.jelectrocard.2010.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Indexed: 01/18/2023]
Abstract
Atrial fibrillation (AF) is the main cause of stroke and the most common sustained arrhythmia, afflicting about 2.3 million Americans. Clinical treatment and management of AF would benefit from a noninvasive and global assessment of the arrhythmia; however, that avenue seems currently limited in part by our poor understanding of arrhythmia itself. Experimental studies of AF in the isolated sheep heart demonstrated that high-frequency sources in the posterior wall of the left atrium drive the fibrillatory activity throughout both atria. Motivated by those results and by a growing body of work investigating how measurements of the cycle length of activity in patients during AF can contribute to its treatment, we focused our analysis on the dispersion of dominant frequency (DF) of the activity during AF in humans. Using electroanatomic mapping and Fourier methods, we generated 3-dimensional intracardiac DF maps of the atria in patients before AF ablation procedures and identified relatively small high-DF (HDF) sites. In patients with paroxysmal AF, the HDF sites are often localized to the posterior left atrium near the ostia of the pulmonary veins. In contrast, patients with permanent AF demonstrate HDF sites that are more often localized to the atria than the posterior left atrium-pulmonary vein junction. In our study, ablation at HDF sites resulted in significant slowing of the arrhythmia and termination of sustained AF in 87% of patients with paroxysmal AF. Furthermore, we found that abolishing, by ablation, preexisting left atrium to right atrium DF gradients predicted long-term freedom of AF in both paroxysmal and persistent AF patients. Overall, the analysis of intracardiac electrical recordings in the frequency domain has greatly enhanced our understanding of its underlying mechanisms and may contribute to monitoring drug effects and guide ablation procedures aiming at its termination. On the other hand, current body surface mapping methods have also suggested better correlations between surface AF frequency and intracardiac local DFs as compared with spatiotemporal activation patterns. Therefore, further study of the correlation of spectral observables obtained from the atria and from the surface electrocardiogram during AF seems to have the potential to advance our ability to diagnose and discern mechanisms of AF noninvasively.
Collapse
|
35
|
Yoshida K, Chugh A, Good E, Crawford T, Myles J, Veerareddy S, Billakanty S, Wong WS, Ebinger M, Pelosi F, Jongnarangsin K, Bogun F, Morady F, Oral H. A critical decrease in dominant frequency and clinical outcome after catheter ablation of persistent atrial fibrillation. Heart Rhythm 2009; 7:295-302. [PMID: 20117058 DOI: 10.1016/j.hrthm.2009.11.024] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 11/19/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Termination of persistent atrial fibrillation (AF) by radiofrequency ablation (RFA) is associated with a high probability of freedom from AF but requires extensive ablation and long procedure times. OBJECTIVE The purpose of this study was to determine whether a critical decrease in the dominant frequency (DF) of AF is a sufficient endpoint for RFA of persistent AF. METHODS Antral pulmonary vein isolation (APVI) followed by RFA of complex fractionated atrial electrograms (CFAEs) in the atria and coronary sinus was performed in 100 consecutive patients with persistent AF. The DF of AF in lead V1 and in the coronary sinus was determined by fast Fourier transform (FFT) analysis at baseline and before termination of AF to identify a critical decrease in DF predictive of sinus rhythm after RFA. RESULTS A > or =11% decrease in DF had the highest accuracy in predicting freedom from atrial arrhythmias, with a sensitivity of 0.71 and a specificity of 0.82 (P <.001). At a mean follow-up of 14 +/- 3 months after one ablation procedure, sinus rhythm was maintained off antiarrhythmic drugs in 8/35 (23%) and 20/26 (77%) of patients with a <11% and > or =11% decrease in DF, respectively (P <.001). Sinus rhythm was maintained in 24/39 patients (62%) in whom RFA terminated AF. The duration of RFA and total procedure time were longer in patients with AF termination (95 +/- 23 and 358 +/- 87 minutes) than in patients with a <11% decrease in the DF (77 +/- 16 and 293 +/- 70 minutes) or > or =11% decrease in DF (80 +/- 17 and 289 +/- 73 minutes), respectively (P <.01). Among the variables of age, gender, left atrial diameter, duration of AF, left ventricular ejection fraction, duration of RFA, a > or =11% decrease in DF, and termination of AF, a > or =11% decrease in DF (odds ratio = 9.89, 95% confidence interval [CI] 2.84-34.47) and termination during RFA (OR = 4.38, 95% CI 1.50-12.80) were the only independent predictors of freedom from recurrent atrial arrhythmias. CONCLUSION In a retrospective analysis of consecutive patients with persistent AF, a decrease in the DF of AF by 11% in response to APVI and ablation of CFAEs was associated with a probability of maintaining sinus rhythm that was similar to that when RFA terminates AF.
Collapse
Affiliation(s)
- Kentaro Yoshida
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Krummen DE, Peng KA, Bullinga JR, Narayan SM. Centrifugal gradients of rate and organization in human atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:1366-78. [PMID: 19744279 DOI: 10.1111/j.1540-8159.2009.02525.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Animal studies show that atrial fibrillation (AF) may emanate from sites of high rate and regularity, with fibrillatory conduction to adjacent areas. We used simultaneous mapping to find evidence for potential drivers in human AF defined as sites with higher rate and regularity than surrounding tissue. MATERIALS AND METHODS In 24 patients (age 61+/-10 years; 12 persistent), we recorded AF simultaneously from 32 left atrial bipolar basket electrodes in addition to pulmonary veins (PV), coronary sinus, and right atrial electrodes. We measured AF cycle length (CL) by Fourier transform and electrogram regularity at each electrode, referenced to patient-specific atrial anatomy. RESULTS We analyzed 10,298 electrode-periods. Evidence for potential AF drivers was found in 11 patients (five persistent). In persistent AF, these sites lay at the coronary sinus and left atrial roof but not PVs, while in paroxysmal AF six of nine sites lay at PVs (P<0.05). During ablation, a subset of patients experienced AF CL prolongation or termination with a focal lesion; in each case this lesion mapped to potential driver sites on blinded analysis. Conversely, sequential mapping failed to reveal these sites, possibly due to fluctuations in dominant frequency at driver locations in the context of migratory AF. CONCLUSIONS Simultaneous multisite recordings in human AF reveal evidence for drivers that lie near PVs in paroxysmal but not persistent AF, and were sites where ablation slowed or terminated AF in a subset of patients. The future work should determine if real-time ablation of AF-maintaining regions defined in this fashion eliminates AF.
Collapse
Affiliation(s)
- David E Krummen
- University of California San Diego and VA San Diego Healthcare System, San Diego, California 92161, USA.
| | | | | | | |
Collapse
|
37
|
Kim AM, Olgin JE, Everett TH. Role of atrial substrate and spatiotemporal organization in atrial fibrillation. Heart Rhythm 2009; 6:S1-7. [DOI: 10.1016/j.hrthm.2009.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Indexed: 10/21/2022]
|
38
|
Relationship between the spectral characteristics of atrial fibrillation and atrial tachycardias that occur after catheter ablation of atrial fibrillation. Heart Rhythm 2009; 6:e1a; author reply e1b. [PMID: 19389643 DOI: 10.1016/j.hrthm.2009.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Indexed: 11/22/2022]
|
39
|
Yoshida K, Chugh A, Ulfarsson M, Good E, Kuhne M, Crawford T, Sarrazin JF, Chalfoun N, Wells D, Boonyapisit W, Veerareddy S, Billakanty S, Wong WS, Jongnarangsin K, Pelosi F, Bogun F, Morady F, Oral H. Relationship between the spectral characteristics of atrial fibrillation and atrial tachycardias that occur after catheter ablation of atrial fibrillation. Heart Rhythm 2009; 6:11-7. [DOI: 10.1016/j.hrthm.2008.09.031] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 09/25/2008] [Indexed: 11/26/2022]
|
40
|
Ciaccio EJ, Biviano AB, Whang W, Wit AL, Garan H, Coromilas J. New methods for estimating local electrical activation rate during atrial fibrillation. Heart Rhythm 2009; 6:21-32. [PMID: 19121796 DOI: 10.1016/j.hrthm.2008.10.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 10/08/2008] [Indexed: 10/21/2022]
|
41
|
Alcaraz R, Rieta JJ. Adaptive singular value cancelation of ventricular activity in single-lead atrial fibrillation electrocardiograms. Physiol Meas 2008; 29:1351-69. [PMID: 18946157 DOI: 10.1088/0967-3334/29/12/001] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The proper analysis and characterization of atrial fibrillation (AF) from surface electrocardiographic (ECG) recordings requires to cancel out the ventricular activity (VA), which is composed of the QRS complex and the T wave. Historically, for single-lead ECGs, the averaged beat subtraction (ABS) has been the most widely used technique. However, this method is very sensitive to QRST wave variations and, moreover, high-quality cancelation templates may be difficult to obtain when only short length and single-lead recordings are available. In order to overcome these limitations, a new QRST cancelation method based on adaptive singular value cancelation (ASVC) applied to each single beat is proposed. In addition, an exhaustive study about the optimal set of complexes for better cancelation of every beat is also presented for the first time. The whole study has been carried out with both simulated and real AF signals. For simulated AF, the cancelation performance was evaluated making use of a cross-correlation index and the normalized mean square error (nmse) between the estimated and the original atrial activity (AA). For real AF signals, two additional new parameters were proposed. First, the ventricular residue (VR) index estimated the presence of ventricular activity in the extracted AA. Second, the similarity (S) evaluated how the algorithm preserved the AA segments out of the QRST interval. Results indicated that for simulated AF signals, mean correlation, nmse, VR and S values were 0.945 +/- 0.024, 0.332 +/- 0.073, 1.552 +/- 0.386 and 0.986 +/- 0.012, respectively, for the ASVC method and 0.866 +/- 0.042, 0.424 +/- 0.120, 2.161 +/- 0.564 and 0.922 +/- 0.051 for ABS. In the case of real signals, the mean VR and S values were 1.725 +/- 0.826 and 0.983 +/- 0.038, respectively, for ASVC and 3.159 +/- 1.097 and 0.951 +/- 0.049 for ABS. Thus, ASVC provides a more accurate beat-to-beat ventricular QRST representation than traditional techniques. As a consequence, VA cancelation is optimized and the AA can be extracted more precisely. Finally, the study has proven that optimal VA cancelation is achieved when a number between 20 and 30 complexes is selected following a correlation-based strategy.
Collapse
Affiliation(s)
- Raúl Alcaraz
- Innovation in Bioengineering Research Group, University of Castilla-La Mancha, Campus Universitario, 16071, Cuenca, Spain.
| | | |
Collapse
|