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Squara F, Scarlatti D, Bun SS, Moceri P, Ferrari E, Meste O, Zarzoso V. Fibrillatory Wave Amplitude Evolution during Persistent Atrial Fibrillation Ablation: Implications for Atrial Substrate and Fibrillation Complexity Assessment. J Clin Med 2022; 11:jcm11154519. [PMID: 35956135 PMCID: PMC9369560 DOI: 10.3390/jcm11154519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background. Fibrillatory Wave Amplitude (FWA) has been described as a non-invasive marker of atrial fibrillation (AF) complexity, and it predicts catheter ablation outcome. However, the actual determinants of FWA remain incompletely understood. Objective. To assess the respective implications of anatomical atrial substrate and AF spectral characteristics for FWA. Methods. Persistent AF patients undergoing radiofrequency catheter ablation were included. FWA was measured on 1-min ECG by TQ concatenation in Lead I, V1, V2, and V5 at baseline and immediately before AF termination. FWA evolution during ablation was compared to that of AF dominant frequency (DF) measured by Independent Component Analysis on 12-lead ECG. FWA was compared to the extent of endocardial low-voltage areas (LVA I < 10%; II 10–20%; III 20–30%; IV > 30%), to the surface of healthy left atrial tissue, and to P-wave amplitude in sinus rhythm. The predictive value of FWA for AF recurrence during follow-up was assessed. Results. We included 29 patients. FWA remained stable along ablation procedure with comparable values at baseline and before AF termination (Lead I p = 0.54; V1 p = 0.858; V2 p = 0.215; V5 p = 0.14), whereas DF significantly decreased (5.67 ± 0.68 vs. 4.95 ± 0.58 Hz, p < 0.001). FWA was higher in LVA-I than in LVA-II, -III, and -IV in Lead I and V5 (p = 0.02 and p = 0.01). FWA in V5 was strongly correlated with the surface of healthy left atrial tissue (R = 0.786; p < 0.001). FWA showed moderate to strong correlation to P-wave amplitude in all leads. Finally, FWA did not predict AF recurrence after a follow-up of 23.3 ± 9.8 months. Conclusions. These findings suggest that FWA is unrelated to AF complexity but is mainly determined by the amount of viable atrial myocytes. Therefore, FWA should only be referred as a marker of atrial tissue pathology.
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Affiliation(s)
- Fabien Squara
- Cardiology Department, Université Côte d’Azur, Pasteur Hospital, 30 Avenue de la Voie Romaine, 06000 Nice, France; (D.S.); (S.-S.B.); (P.M.); (E.F.)
- I3S Laboratory, Université Côte d’Azur, CNRS, 06900 Sophia Antipolis, France; (O.M.); (V.Z.)
- Correspondence: ; Tel.: +33-6-2016-5829
| | - Didier Scarlatti
- Cardiology Department, Université Côte d’Azur, Pasteur Hospital, 30 Avenue de la Voie Romaine, 06000 Nice, France; (D.S.); (S.-S.B.); (P.M.); (E.F.)
| | - Sok-Sithikun Bun
- Cardiology Department, Université Côte d’Azur, Pasteur Hospital, 30 Avenue de la Voie Romaine, 06000 Nice, France; (D.S.); (S.-S.B.); (P.M.); (E.F.)
| | - Pamela Moceri
- Cardiology Department, Université Côte d’Azur, Pasteur Hospital, 30 Avenue de la Voie Romaine, 06000 Nice, France; (D.S.); (S.-S.B.); (P.M.); (E.F.)
| | - Emile Ferrari
- Cardiology Department, Université Côte d’Azur, Pasteur Hospital, 30 Avenue de la Voie Romaine, 06000 Nice, France; (D.S.); (S.-S.B.); (P.M.); (E.F.)
| | - Olivier Meste
- I3S Laboratory, Université Côte d’Azur, CNRS, 06900 Sophia Antipolis, France; (O.M.); (V.Z.)
| | - Vicente Zarzoso
- I3S Laboratory, Université Côte d’Azur, CNRS, 06900 Sophia Antipolis, France; (O.M.); (V.Z.)
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Ortigosa N, Cano Ó, Sandberg F. Characterization of Changes in P-Wave VCG Loops Following Pulmonary-Vein Isolation. SENSORS 2021; 21:s21051923. [PMID: 33803483 PMCID: PMC7967183 DOI: 10.3390/s21051923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 11/25/2022]
Abstract
Atrial fibrillation is the most common type of cardiac arrhythmia in clinical practice. Currently, catheter ablation for pulmonary-vein isolation is a well-established treatment for maintaining sinus rhythm when antiarrhythmic drugs do not succeed. Unfortunately, arrhythmia recurrence after catheter ablation remains common, with estimated rates of up to 45%. A better understanding of factors leading to atrial-fibrillation recurrence is needed. Hence, the aim of this study is to characterize changes in the atrial propagation pattern following pulmonary-vein isolation, and investigate the relation between such characteristics and atrial-fibrillation recurrence. Fifty patients with paroxysmal atrial fibrillation who had undergone catheter ablation were included in this study. Time-segment and vectorcardiogram-loop-morphology analyses were applied to characterize P waves extracted from 1 min long 12-lead electrocardiogram segments before and after the procedure, respectively. Results showed that P-wave vectorcardiogram loops were significantly less round and more planar, P waves and PR intervals were significantly shorter, and heart rate was significantly higher after the procedure. Differences were larger for patients who did not have arrhythmia recurrences at 2 years of follow-up; for these patients, the pre- and postprocedure P waves could be identified with 84% accuracy.
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Affiliation(s)
- Nuria Ortigosa
- I.U. Matemática Pura y Aplicada, Universitat Politècnica de València, Camino de Vera s/n, Edif. 8E, Acceso F, 46022 Valencia, Spain
- Correspondence:
| | - Óscar Cano
- Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Planta 4-Torre F, Av. Fernando Abril Martorell 106, 46026 Valencia, Spain;
- Centro de Investigaciones Biomédicas en Red en Enfermedades Cardiovasculares (CIBERCV), 3, 28029 Madrid, Spain
| | - Frida Sandberg
- Department of Biomedical Engineering, Lund University, Box 118, 221 00 Lund, Sweden;
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Short-term reproducibility of parameters characterizing atrial fibrillatory waves. Comput Biol Med 2020; 117:103613. [DOI: 10.1016/j.compbiomed.2020.103613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/04/2020] [Accepted: 01/07/2020] [Indexed: 11/21/2022]
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