1
|
Liu Z, Xia Y, Guo C, Li X, Fang P, Yin X, Yang X. Low-Voltage Zones as the Atrial Fibrillation Substrates: Relationship With Initiation, Perpetuation, and Termination. Front Cardiovasc Med 2021; 8:705510. [PMID: 34409078 PMCID: PMC8365032 DOI: 10.3389/fcvm.2021.705510] [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] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Low-voltage zones (LVZs) were usually targeted for ablation in atrial fibrillation (AF). However, its relationship with AF initiation, perpetuation, and termination remains to be studied. This study aimed to explore such relationships. Methods: A total of 126 consecutive AF patients were enrolled, including 71 patients for AF induction protocol and 55 patients for AF termination protocol. Inducible and sustainable AF were defined as induced AF lasting over 30 and 300 s, respectively. Terminable AF was defined as those that could be terminated into sinus rhythm within 1 h after ibutilide administration. Voltage mapping was performed in sinus rhythm for all patients. LVZ was quantified as the percentage of the LVZ area (LVZ%) to the left atrium surface area. Results: The rates of inducible, sustainable, and terminable AF were 29.6, 18.3, and 38.2%, respectively. Inducible AF patients had no significant difference in overall LVZ% compared with uninducible AF patients (10.2 ± 11.8 vs. 8.5 ± 12.6, p = 0.606), while sustainable and interminable AF patients had larger overall LVZ% than unsustainable (16.2 ± 11.5 vs. 0.5 ± 0.7, p < 0.001) and terminable AF patients (44.6 ± 26.4 vs. 26.3 ± 22.3, p < 0.05), respectively. The segmental LVZ distribution pattern was diverse in the different stages of AF. Segmental LVZ% difference was initially observed in the anterior wall for patients with inducible AF, and the septum was further affected in those with sustainable AF, and the roof, posterior wall, and floor were finally affected in those with interminable AF. Conclusions: The associations between LVZ with AF initiation, perpetuation, and termination were different depending on its size and distribution.
Collapse
Affiliation(s)
- Zheng Liu
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yu Xia
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changyan Guo
- Department of Cardiology, Xilin Gol League Central Hospital, Inner Mongolia, Xilinhot, China
| | - Xiaofeng Li
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pihua Fang
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiandong Yin
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinchun Yang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
2
|
Goldenthal IL, Ciaccio EJ, Sciacca RR, Garan H, Biviano AB. Increased body mass index, age, and left atrial size are associated with altered intracardiac atrial electrograms in persistent atrial fibrillation patients. J Interv Card Electrophysiol 2021; 62:569-577. [PMID: 33432475 DOI: 10.1007/s10840-020-00933-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 12/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are limited studies evaluating whether atrial fibrillation (AF) patients with increased BMI, age, and left atrial (LA) size have altered intracardiac electrogram (EGM) morphology. METHODS We analyzed left atrial intracardiac EGMs acquired during invasive electrophysiology study in 54 patients with AF. EGM correlations were assessed among AF risk factors including age, left atrial size, and BMI. RESULTS BMI correlated positively with DF (r2 = 0.17, p = 0.009) and MP (r2 = 0.16, p = 0.01) with dominant frequency (DF) and mean spectral profile (MP) greater among obese individuals. Age was negatively associated with mean amplitude (r2 = 0.42, p < 0.001) and width (r2 = 0.32, p < 0.001); age was positively correlated with MP (r2 = 0.24, p < 0.001). LA size was negatively correlated with mean amplitude (r2 = 0.18, p = 0.03) and width (r2 = 0.23, p = 0.01); LA size was positively correlated with DF (r2 = 0.22, p = 0.01) and MP (r2 = 0.23, p = 0.01). Mean amplitude and width were decreased among subjects with a severely enlarged LA; DF and MP were increased in those with severely enlarged LA. The associations with BMI and LA size remained significant in multiple regression models that included age, male gender, time since AF diagnosis, and LVEF. CONCLUSIONS EGM morphology of AF patients with increased BMI, older age, and an enlarged LA possessed decreased amplitude and decreased width and increased DF and MP. These findings suggest that atrial remodeling due to increased age, LA size, and BMI is associated with differences in local atrial activation, decreased refractoriness, and more heterogeneous activation. These novel findings point out clinical risk factors for atrial fibrillation that may affect electrogram characteristics.
Collapse
Affiliation(s)
- Isaac L Goldenthal
- Internal Medicine, Division of Cardiology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA
| | - Edward J Ciaccio
- Internal Medicine, Division of Cardiology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA
| | - Robert R Sciacca
- Internal Medicine, Division of Cardiology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA
| | - Hasan Garan
- Internal Medicine, Division of Cardiology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA
| | - Angelo B Biviano
- Internal Medicine, Division of Cardiology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA.
- Columbia University Irving Medical Center, 161 Fort Washington Ave #546, New York, NY, 10032, USA.
| |
Collapse
|
3
|
Biviano AB, Ciaccio EJ, Fleitman J, Knotts R, Lawrence J, Haynes N, Cyrille N, Hickey K, Iyer V, Wan E, Whang W, Garan H. Atrial Tachycardias After Atrial Fibrillation Ablation Manifest Different Waveform Characteristics: Implications for Characterizing Tachycardias. J Cardiovasc Electrophysiol 2015; 26:1187-1195. [PMID: 26228873 DOI: 10.1111/jce.12770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/06/2015] [Accepted: 07/10/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) ablation patients often manifest atrial tachycardias (AT) with atypical ECG morphologies that preclude accurate localization and mechanism. Diagnostic maneuvers used to define ATs during electrophysiology studies can be limited by tachycardia termination or transformation. Additional methods of characterizing post-AF ablation ATs are required. METHODS AND RESULTS We evaluated the utility of noninvasive ECG signal analytics in postablation AF patients for the following features: (1) Localization of ATs (i.e., right vs. left atrium), and (2) Identification of common left AT mechanisms (i.e., focal vs. macroreentrant). Atrial waveforms from the surface ECG were used to analyze (1) spectral organization, including dominant amplitude (DA) and mean spectral profile (MP), and (2) temporospatial variability, using temporospatial correlation coefficients. We studied 94 ATs in 71 patients who had undergone prior pulmonary vein isolation for AF and returned for a second ablation: (1) right atrial cavotricuspid-isthmus dependent (CTI) ATs (n = 21); (2) left atrial macroreentrant ATs (n = 41) and focal ATs (n = 32). Right CTI ATs manifested higher DAs and lower MPs than left ATs, indicative of greater stability and less complexity in the frequency spectrum. Left macroreentrant ATs possessed higher temporospatial organization than left focal ATs. CONCLUSIONS Noninvasively recorded atrial waveform signal analyses show that right ATs possess more stable activation properties than left ATs, and left macroreentrant ATs manifest higher temporospatial organization than left focal ATs. Further prospective analyses evaluating the role these novel ECG-derived tools can play to help localize and identify mechanisms of common ATs in AF ablation patients are warranted.
Collapse
Affiliation(s)
- Angelo B Biviano
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.,Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Edward J Ciaccio
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.,Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Jessica Fleitman
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.,Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Robert Knotts
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.,Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - John Lawrence
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.,Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Norrisa Haynes
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.,Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Nicole Cyrille
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.,Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Kathleen Hickey
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.,Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Vivek Iyer
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.,Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Elaine Wan
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.,Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - William Whang
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.,Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Hasan Garan
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.,Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA
| |
Collapse
|
4
|
Biviano AB, Ciaccio EJ, Knotts R, Fleitman J, Lawrence J, Iyer V, Whang W, Garan H. Atrial electrogram discordance during baseline vs reinduced atrial fibrillation: Potential ramifications for ablation procedures. Heart Rhythm 2015; 12:1448-55. [PMID: 25818256 PMCID: PMC4485587 DOI: 10.1016/j.hrthm.2015.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND There are scant data comparing the electrogram (EGM) signal characteristics of atrial fibrillation (AF) at baseline vs electrically induced states during ablation procedures. OBJECTIVE The purpose of this study was to use novel intracardiac signal analysis techniques to gain insights into the effects of catheter ablation and AF reinduction on AF EGMs in patients with persistent AF. METHODS We collected left atrial EGMs in patients undergoing first ablation for persistent AF at 3 time intervals: (1) AF at baseline; (2) AF after pulmonary vein isolation (PVI); and (3) AF after post-PVI cardioversion and subsequent reinduction. We analyzed 2 EGM spectral characteristics: (1) dominant frequency and (2) spectral complexity; and 2 EGM morphologic characteristics: (1) morphology variation and (2) pattern repetitiveness. RESULTS There were no differences in AF dominant frequency, dominant amplitude, spectral complexity, or metrics of EGM morphology or repetitiveness at baseline vs after PVI. However, dominant frequency, dominant amplitude, and spectral complexity differed significantly after direct current cardioversion and reinduction of AF. CONCLUSION The frequency, spectral complexity, and local EGM morphologies of AF do not significantly change over the course of a PVI procedure in patients with persistent AF. However, reinduction of AF after direct current cardioversion results in different dominant frequency and spectral complexity, consistent with a change in the characteristics of the perpetuating source(s) of the newly induced AF. These data suggest that AF properties can vary significantly between baseline and reinduced AF, with potential clinical ramifications for outcomes of catheter ablation procedures.
Collapse
Affiliation(s)
- Angelo B Biviano
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York.
| | - Edward J Ciaccio
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York
| | - Robert Knotts
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jessica Fleitman
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York
| | - John Lawrence
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York
| | - Vivek Iyer
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York
| | - William Whang
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York
| | - Hasan Garan
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York
| |
Collapse
|