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Zuhair M, Keene D, Kanagaratnam P, Lim PB. Percutaneous Neuromodulation for Atrial Fibrillation. Card Electrophysiol Clin 2024; 16:281-296. [PMID: 39084721 DOI: 10.1016/j.ccep.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Percutaneous neuromodulation is emerging as a promising therapeutic approach for atrial fibrillation (AF). This article explores techniques such as ganglionated plexi (GP) ablation, and vagus nerve stimulation, pinpointing their potential in modulating AF triggers and maintenance. Noninvasive methods, such as transcutaneous low-level tragus stimulation, offer innovative treatment pathways, with early trials indicating a significant reduction in AF burden. GP ablation may address autonomic triggers, and the potential for GP ablation in neuromodulation is discussed. The article stresses the necessity for more rigorous clinical trials to validate the safety, reproducibility, and efficacy of these neuromodulation techniques in AF treatment.
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Affiliation(s)
- Mohamed Zuhair
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK.
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
| | - Prapa Kanagaratnam
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
| | - Phang Boon Lim
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
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2
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Okishige K, Kawaguchi N, Shigeta T, Yamauchi Y, Sasaki T, Keida T, Tanno K, Hirao K, Sasano T. Quantitative investigation of acute lesions created by ethanol infusion into the vein of Marshall. Heart Rhythm 2024:S1547-5271(24)02828-5. [PMID: 38960305 DOI: 10.1016/j.hrthm.2024.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Ethanol infusion into the vein of Marshall (EIVOM) has been performed as an adjunctive atrial fibrillation therapy. However, the time course change, quantitative lesion investigation, and effects on epicardial fat pads and fractionated atrial electrograms created by EIVOM have never been investigated. OBJECTIVE This study aimed to perform a quantitative analysis of lesions created by EIVOM. METHODS We created voltage maps using a 3-dimensional mapping system immediately before and 30 minutes and 60 minutes after performing EIVOM to study the time course change in the lesions. We compared differences in the average contact force value required for successful conduction block in the Marshall vein area of patients with and without EIVOM. We also investigated effects of EIVOM on the area of complex fractionated atrial electrograms before and after EIVOM. We measured the total epicardial fat pad volume before and after EIVOM by computed tomography. RESULTS Voltage was significantly reduced after EIVOM, and there were significant differences in voltage reduction between the control status and 30 minutes and 60 minutes after EIVOM (P < .05). The average contact force value was significantly lower with vs without EIVOM (P < .05). The total epicardial fat volume and complex fractionated atrial electrogram area also significantly decreased after EIVOM (P < .05). CONCLUSION EIVOM provided significant therapeutic effects on the left atrial tissue perpetuating atrial fibrillation, which was demonstrated by a quantitative analysis.
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Affiliation(s)
- Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Kanagawa, Japan.
| | - Naohiko Kawaguchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Kanagawa, Japan
| | - Takatoshi Shigeta
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Kanagawa, Japan
| | - Yasuteru Yamauchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Kanagawa, Japan
| | - Takeshi Sasaki
- Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehiko Keida
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Kaoru Tanno
- Department of Cardiology, Syowa University, School of Medicine, Tokyo, Japan
| | - Kenzo Hirao
- Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan
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3
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Silva Garcia E, Lobo-Torres I, Fernández-Armenta J, Penela D, Fernandez-Garcia M, Gomez-Lopez A, Soto-Iglesias D, Fernández-Rivero R, Vazquez-Garcia R, Acosta J, Bisbal F, Cano-Calabria L, Berruezo A. Functional mapping to reveal slow conduction and substrate progression in atrial fibrillation. Europace 2023; 25:euad246. [PMID: 37961921 PMCID: PMC10644200 DOI: 10.1093/europace/euad246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/11/2023] [Indexed: 11/15/2023] Open
Abstract
AIMS The aim of our study was to analyse the response to short-coupled atrial extrastimuli to identify areas of hidden slow conduction (HSC) and their relationship with the atrial fibrillation (AF) phenotype. METHODS AND RESULTS Twenty consecutive patients with paroxysmal AF and persistent AF (10:10) underwent the first pulmonary vein isolation procedure. Triple short-coupled extrastimuli were delivered in sinus rhythm (SR), and the evoked response was analysed: sites exhibiting double or highly fragmented electrograms (EGM) were defined as positive for HSC (HSC+). The delta of the duration of the bipolar EGM was analysed, and bipolar EGM duration maps were built. High-density maps were acquired using a multipolar catheter during AF, SR, and paced rhythm. Spatial co-localization of HSC+ and complex fractionated atrial EGMs (CFAE) during AF was evaluated. Persistent AF showed a higher number and percentage of HSC+ than paroxysmal AF (13.9% vs. 3.3%, P < 0.001). The delta of EGM duration was 53 ± 22 ms for HSC+ compared with 13 ± 11 (10) ms in sites with negative HSC (HSC-) (P < 0.001). The number and density of HSC+ were lower than CFAE during AF (19 vs. 56 per map, P < 0.001). The reproducibility and distribution of HSC+ in repeated maps were superior to CFAE (P = 0.19 vs. P < 0.001). Sites with negative and positive responses showed a similar bipolar voltage in the preceding sinus beat (1.65 ± 1.34 and 1.48 ± 1.47 mV, P = 0.12). CONCLUSION Functional mapping identifies more discrete and reproducible abnormal substrates than mapping during AF. The HSC+ sites in response to triple extrastimuli are more frequent in persistent AF than in paroxysmal AF.
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Affiliation(s)
- Etel Silva Garcia
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Ivan Lobo-Torres
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | - Diego Penela
- Teknon Medical Center, Heart Institute, Barcelona, Spain
| | | | - Andrea Gomez-Lopez
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | | | | | - Juan Acosta
- Department of Cardiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Felipe Bisbal
- Institut del Cor (iCor), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Lucas Cano-Calabria
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
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4
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Regions of Highly Recurrent Electrogram Morphology With Low Cycle Length Reflect Substrate for Atrial Fibrillation. JACC. BASIC TO TRANSLATIONAL SCIENCE 2022; 8:68-84. [PMID: 36777167 PMCID: PMC9911322 DOI: 10.1016/j.jacbts.2022.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/27/2022]
Abstract
Traditional anatomically guided ablation and attempts to perform electrogram-guided atrial fibrillation (AF) ablation (CFAE, DF, and FIRM) have not been shown to be sufficient treatment for persistent AF. Using biatrial high-density electrophysiologic mapping in a canine rapid atrial pacing model of AF, we systematically investigated the relationship of electrogram morphology recurrence (EMR) (Rec% and CLR) with established AF electrogram parameters and tissue characteristics. Rec% correlates with stability of rotational activity and with the spatial distribution of parasympathetic nerve fibers. These results have indicated that EMR may therefore be a viable therapeutic target in persistent AF.
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Key Words
- AF, atrial fibrillation
- AI, anisotropy index
- CFAE, complex fractionated atrial electrogram
- CLR, cycle length of the most recurrent electrogram morphology
- DF, dominant frequency
- EGM, electrogram
- EMR, electrogram morphology recurrence
- FFT, fast Fourier transform
- FI, fractionation interval
- FIRM, focal impulse and rotor mapping
- LAA, left atrial appendage
- LAFW, left atrial free wall
- LAT, local activation time
- OI, organization index
- PLA, posterior left atrium
- PV, pulmonary vein
- RAA, right atrial appendage
- RAFW, right atrial free wall
- RAP, rapid atrial pacing
- Rec%, recurrence percentage
- ShEn, Shannon’s entropy
- arrhythmias
- atrial fibrillation
- fibrosis
- mapping
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Finotti E, Quesada A, Ciaccio EJ, Garan H, Hornero F, Alcaraz R, Rieta JJ. Practical Considerations for the Application of Nonlinear Indices Characterizing the Atrial Substrate in Atrial Fibrillation. ENTROPY (BASEL, SWITZERLAND) 2022; 24:1261. [PMID: 36141147 PMCID: PMC9497841 DOI: 10.3390/e24091261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and in response to increasing clinical demand, a variety of signals and indices have been utilized for its analysis, which include complex fractionated atrial electrograms (CFAEs). New methodologies have been developed to characterize the atrial substrate, along with straightforward classification models to discriminate between paroxysmal and persistent AF (ParAF vs. PerAF). Yet, most previous works have missed the mark for the assessment of CFAE signal quality, as well as for studying their stability over time and between different recording locations. As a consequence, an atrial substrate assessment may be unreliable or inaccurate. The objectives of this work are, on the one hand, to make use of a reduced set of nonlinear indices that have been applied to CFAEs recorded from ParAF and PerAF patients to assess intra-recording and intra-patient stability and, on the other hand, to generate a simple classification model to discriminate between them. The dominant frequency (DF), AF cycle length, sample entropy (SE), and determinism (DET) of the Recurrence Quantification Analysis are the analyzed indices, along with the coefficient of variation (CV) which is utilized to indicate the corresponding alterations. The analysis of the intra-recording stability revealed that discarding noisy or artifacted CFAE segments provoked a significant variation in the CV(%) in any segment length for the DET and SE, with deeper decreases for longer segments. The intra-patient stability provided large variations in the CV(%) for the DET and even larger for the SE at any segment length. To discern ParAF versus PerAF, correlation matrix filters and Random Forests were employed, respectively, to remove redundant information and to rank the variables by relevance, while coarse tree models were built, optimally combining high-ranked indices, and tested with leave-one-out cross-validation. The best classification performance combined the SE and DF, with an accuracy (Acc) of 88.3%, to discriminate ParAF versus PerAF, while the highest single Acc was provided by the DET, reaching 82.2%. This work has demonstrated that due to the high variability of CFAEs data averaging from one recording place or among different recording places, as is traditionally made, it may lead to an unfair oversimplification of the CFAE-based atrial substrate characterization. Furthermore, a careful selection of reduced sets of features input to simple classification models is helpful to accurately discern the CFAEs of ParAF versus PerAF.
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Affiliation(s)
- Emanuela Finotti
- BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain
| | - Aurelio Quesada
- Arrhythmia Unit, Cardiology Department, General University Hospital Consortium of Valencia, 46014 Valencia, Spain
| | - Edward J. Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY 10032, USA
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY 10032, USA
| | - Fernando Hornero
- Cardiovascular Surgery Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - Raúl Alcaraz
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 16071 Cuenca, Spain
| | - José J. Rieta
- BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain
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Barletta V, Mazzocchetti L, Parollo M, Spatafora D, Bongiorni M, Zucchelli G. Multimodality imaging for atrial fibrosis detection in the era of precision medicine. J Cardiovasc Echogr 2021; 31:189-197. [PMID: 35284213 PMCID: PMC8893107 DOI: 10.4103/jcecho.jcecho_61_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/04/2022] Open
Abstract
In recent years, atrial fibrillation (AF) has increasingly become a focus of attention because it represents the most encountered arrhythmia in clinical practice and a major cause of morbidity and mortality. Issues underlying AF have long been debated; nevertheless, electrical, contractile, and structural remodeling is demonstrated to be the pivotal contributor to arrhythmic substrate. Fibrosis is a hallmark of arrhythmogenic structural remodeling, resulting from an accumulation of fibrillar collagen deposits, as a reparative process to replace degenerating myocardium with concomitant reactive fibrosis, which causes interstitial expansion. Although the precise role of fibrosis in AF initiation and maintenance remains to be fully elucidated, a better definition of its extent and distribution may assist in designing individually tailored ablation approaches and improving procedure outcomes by targeting the fibrotic substrates with an organized strategy employing imaging resources. A deep comprehension of the mechanisms underlying atrial fibrosis could be crucial to setting up improved strategies for preventing AF-promoting structural remodeling. Imaging modalities such as echocardiography, cardiac computed tomography, and cardiac magnetic resonance, combined sometimes with invasive electroanatomical mapping, could provide valuable information for the optimal patients’ management if their use is not limited to cardiac anatomy study but extended to characterize abnormal left atrial substrate. Although pulmonary vein isolation is usually efficacious in treating paroxysmal AF, it is not sufficient for many patients with nonparoxysmal arrhythmias, particularly those with longstanding persistent AF. Noninvasive imaging techniques play a pivotal role in the planning of arrhythmic substrates ablation and show a strong correlation with electro-anatomic mapping, whose novel multipolar mapping catheters allow nowadays a more precise comprehension of atrial substrate. This review aims to explore the impact of the various imaging modalities for the detection of atrial fibrosis and their role in the management of AF.
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7
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Zeemering S, van Hunnik A, van Rosmalen F, Bonizzi P, Scaf B, Delhaas T, Verheule S, Schotten U. A Novel Tool for the Identification and Characterization of Repetitive Patterns in High-Density Contact Mapping of Atrial Fibrillation. Front Physiol 2020; 11:570118. [PMID: 33178041 PMCID: PMC7593698 DOI: 10.3389/fphys.2020.570118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/22/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction Electrical contact mapping provides a detailed view of conduction patterns in the atria during atrial fibrillation (AF). Identification of repetitive wave front propagation mechanisms potentially initiating or sustaining AF might provide more insights into temporal and spatial distribution of candidate AF mechanism and identify targets for catheter ablation. We developed a novel tool based on recurrence plots to automatically identify and characterize repetitive conduction patterns in high-density contact mapping of AF. Materials and Methods Recurrence plots were constructed by first transforming atrial electrograms recorded by a multi-electrode array to activation-phase signals and then quantifying the degree of similarity between snapshots of the activation-phase in the electrode array. An AF cycle length dependent distance threshold was applied to discriminate between repetitive and non-repetitive snapshots. Intervals containing repetitive conduction patterns were detected in a recurrence plot as regions with a high recurrence rate. Intervals that contained similar repetitive patterns were then grouped into clusters. To demonstrate the ability to detect and quantify the incidence, duration and size of repetitive patterns, the tool was applied to left and right atrial recordings in a goat model of different duration of persistent AF [3 weeks AF (3 wkAF, n = 8) and 22 weeks AF (22 wkAF, n = 8)], using a 249-electrode mapping array (2.4 mm inter-electrode distance). Results Recurrence plots identified frequent recurrences of activation patterns in all recordings and indicated a strong correlation between recurrence plot threshold and AF cycle length. Prolonged AF duration was associated with shorter repetitive pattern duration [mean maximum duration 3 wkAF: 74 cycles, 95% confidence interval (54-94) vs. 22 wkAF: 41 cycles (21-62), p = 0.03], and smaller recurrent regions within repetitive patterns [3 wkAF 1.7 cm2 (1.0-2.3) vs. 22 wkAF 0.5 cm2 (0.0-1.2), p = 0.02]. Both breakthrough patterns and re-entry were identified as repetitive conduction patterns. Conclusion Recurrence plots provide a novel way to delineate high-density contact mapping of AF. Dominant repetitive conduction patterns were identified in a goat model of sustained AF. Application of the developed methodology using the new generation of multi-electrode catheters could identify additional targets for catheter ablation of AF.
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Affiliation(s)
- Stef Zeemering
- Department of Physiology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Arne van Hunnik
- Department of Physiology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Frank van Rosmalen
- Department of Biomedical Engineering, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Pietro Bonizzi
- Department of Data Science and Knowledge Engineering, Maastricht University, Maastricht, Netherlands
| | - Billy Scaf
- Department of Physiology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Sander Verheule
- Department of Physiology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Ulrich Schotten
- Department of Physiology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
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8
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Ríos-Muñoz GR, Artés-Rodríguez A, Fernández-Avilés F, Arenal Á. Real-Time Ventricular Cancellation in Unipolar Atrial Fibrillation Electrograms. Front Bioeng Biotechnol 2020; 8:789. [PMID: 32850699 PMCID: PMC7406791 DOI: 10.3389/fbioe.2020.00789] [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: 04/29/2020] [Accepted: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
Unipolar atrial fibrillation (AF) electrograms (EGMs) require far-field ventricle cancellation to recover hidden atrial activations. Current methods cannot achieve real-time cancellation because of the temporal delay they introduce. We propose a new real-time ventricular cancellation (RVC) method based on causal implementation optimized for real-time functioning. The method is similar to the classical average beat subtraction (ABS) method but it computes the ventricular contribution before the ventricular activation finishes. We compare the proposed method to the ABS on synthetic and real EGM databases for the time and frequency domains. All parameters and their optimal values are analyzed and validated. The RVC method provides a good reconstruction of the unipolar EGMs and a better local activation time detection than the classical approach with average F1scores 0.7307 and 0.7125, respectively. The spectral analysis shows that the average power after ventricular cancellation is reduced for frequency bands between 3 and 5.5 Hz, demonstrating that the proposed method removes the ventricular component present in the unipolar EGM signals compared to the ABS method. The phase mapping analysis on the RVC method presented lower error when comparing the annotated EGM cycles with the phase inversion intervals. In terms of performance ABS and RVC behave similarly, but the real-time capability of the latter justifies its preference over the offline implementations. In the clinical environment other online investigations, e.g., rotational activity assessment, dominant frequency or local activation time mapping, might benefit from the real-time potential of the proposed cancellation method.
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Affiliation(s)
- Gonzalo R Ríos-Muñoz
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,La Red de Terapia Celular (TerCel), Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | - Antonio Artés-Rodríguez
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Departamento de Teoría de la Señal y Comunicaciones, Universidad Carlos III de Madrid, Madrid, Spain
| | - Francisco Fernández-Avilés
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,La Red de Terapia Celular (TerCel), Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ángel Arenal
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,La Red de Terapia Celular (TerCel), Instituto de Salud Carlos III, Madrid, Spain.,Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
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9
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Ciaccio EJ, Wan EY, Saluja DS, Acharya UR, Peters NS, Garan H. Addressing challenges of quantitative methodologies and event interpretation in the study of atrial fibrillation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 178:113-122. [PMID: 31416540 PMCID: PMC6748794 DOI: 10.1016/j.cmpb.2019.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/21/2019] [Accepted: 06/14/2019] [Indexed: 05/06/2023]
Abstract
Atrial fibrillation (AF) is the commonest arrhythmia, yet the mechanisms of its onset and persistence are incompletely known. Although techniques for quantitative assessment have been investigated, there have been few attempts to integrate this information to advance disease treatment protocols. In this review, key quantitative methods for AF analysis are described, and suggestions are provided for the coordination of the available information, and to develop foci and directions for future research efforts. Quantitative biologists may have an interest in this topic in order to develop machine learning and tools for arrhythmia characterization, but they may perhaps have a minimal background in the clinical methodology and in the types of observed events and mechanistic hypotheses that have thus far been developed. We attempt to address these issues via exploration of the published literature. Although no new data is presented in this review, examples are shown of current lines of investigation, and in particular, how electrogram analysis and whole-chamber quantitative modeling of the left atrium may be useful to characterize fibrillatory patterns of activity, so as to propose avenues for more efficacious acquisition and interpretation of AF data.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine - Division of Cardiology, Columbia University Medical Center, New York, NY, USA; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.
| | - Elaine Y Wan
- Department of Medicine - Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Deepak S Saluja
- Department of Medicine - Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - U Rajendra Acharya
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Hasan Garan
- Department of Medicine - Division of Cardiology, Columbia University Medical Center, New York, NY, USA
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10
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Goette A, Auricchio A, Boriani G, Braunschweig F, Terradellas JB, Burri H, Camm AJ, Crijns H, Dagres N, Deharo JC, Dobrev D, Hatala R, Hindricks G, Hohnloser SH, Leclercq C, Lewalter T, Lip GYH, Merino JL, Mont L, Prinzen F, Proclemer A, Pürerfellner H, Savelieva I, Schilling R, Steffel J, van Gelder IC, Zeppenfeld K, Zupan I, Heidbüchel H, Boveda S, Defaye P, Brignole M, Chun J, Guerra Ramos JM, Fauchier L, Svendsen JH, Traykov VB, Heinzel FR. EHRA White Paper: knowledge gaps in arrhythmia management—status 2019. Europace 2019; 21:993-994. [DOI: 10.1093/europace/euz055] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/15/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Clinicians accept that there are many unknowns when we make diagnostic and therapeutic decisions. Acceptance of uncertainty is essential for the pursuit of the profession: bedside decisions must often be made on the basis of incomplete evidence. Over the years, physicians sometimes even do not realize anymore which the fundamental gaps in our knowledge are. As clinical scientists, however, we have to halt and consider what we do not know yet, and how we can move forward addressing those unknowns. The European Heart Rhythm Association (EHRA) believes that scanning the field of arrhythmia / cardiac electrophysiology to identify knowledge gaps which are not yet the subject of organized research, should be undertaken on a regular basis. Such a review (White Paper) should concentrate on research which is feasible, realistic, and clinically relevant, and should not deal with futuristic aspirations. It fits with the EHRA mission that these White Papers should be shared on a global basis in order to foster collaborative and needed research which will ultimately lead to better care for our patients. The present EHRA White Paper summarizes knowledge gaps in the management of atrial fibrillation, ventricular tachycardia/sudden death and heart failure.
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Affiliation(s)
- Andreas Goette
- St. Vincenz-Krankenhaus GmbH, Cardiology and Intensive Care Medicine, Am Busdorf 2, Paderborn, Germany
- Working Group Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Angelo Auricchio
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano (Ticino), Switzerland
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | | | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - A John Camm
- St. George's, University of London, Molecular and Clinical Sciences Research Institute, London, UK
| | - Harry Crijns
- Department of Cardiology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht UMC+, Maastricht, The Netherlands
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Dobromir Dobrev
- University Duisburg-Essen, Institute of Pharmacology, Essen, Germany
| | - Robert Hatala
- Department of Cardiology and Angiology, National Cardiovascular Institute, NUSCH, Bratislava, Slovak Republic
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, J.W. Goethe University, Frankfurt, Germany
| | | | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital for Internal Medicine Munich South, Munich, Germany
- Department of Cardiology, University of Bonn, Bonn, Germany
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jose Luis Merino
- Hospital Universitario La Paz, Arrhythmia and Robotic EP Unit, Madrid, Spain
| | - Lluis Mont
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Frits Prinzen
- Department of Physiology, Maastricht University, Maastricht, Netherlands
| | | | - Helmut Pürerfellner
- Department of Cardiology, Ordensklinikum Linz Elisabethinen, Academic Teaching Hospital, Linz, Austria
| | - Irina Savelieva
- St. George's, University of London, Molecular and Clinical Sciences Research Institute, London, UK
| | | | - Jan Steffel
- University Heart Center Zurich, Zurich, Switzerland
| | - Isabelle C van Gelder
- Department Of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center (Lumc), Leiden, Netherlands
| | - Igor Zupan
- Department Of Cardiology, University Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - Hein Heidbüchel
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Serge Boveda
- Cardiology Department, Clinique Pasteur, Toulouse, France
| | - Pascal Defaye
- CHU Hôpital Albert Michalon, Unité de Rythmologie Service De Cardiologie, FR-38043 Grenoble Cedex 09, France
| | - Michele Brignole
- Department of Cardiology, Ospedali Del Tigullio, Via Don Bobbio 25, IT-16033 Lavagna (GE), Italy
| | - Jongi Chun
- CCB, Cardiology Department, Med. Klinik Iii, Markuskrankenhaus, Wilhelm Epstein Str. 4, DE-60431 Frankfurt, Germany
| | | | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Université de Tours, Faculté de Médecine, Tours, France
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Frank R Heinzel
- Charité University Medicine, Campus Virchow-Klinikum, Berlin, Germany
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11
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Haldar SK, Jones DG, Khan H, Panikker S, Jarman JWE, Butcher C, Lim E, Wynn G, Gupta D, Hussain W, Markides V, Wong T. Characterising the difference in electrophysiological substrate and outcomes between heart failure and non-heart failure patients with persistent atrial fibrillation. Europace 2018; 20:451-458. [PMID: 28108547 DOI: 10.1093/europace/euw380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/26/2016] [Indexed: 12/24/2022] Open
Abstract
Aims Characterizing the differences in substrate and clinical outcome between heart failure (HF) and non-heart failure (non-HF) patients undergoing persistent atrial fibrillation (AF) ablation. Methods and results Using complex fractionated electrograms (CFE) as a surrogate marker of substrate complexity, we compared the bi-atrial substrate in patients with persistent AF with and without HF, at baseline and after ablation, to determine its impact on clinical outcome. In this retrospective analysis of two prospective studies, 60 patients underwent de-novo step-wise left atrial (LA) ablation, 30 with normal left ventricular ejection fraction (LVEF) ≥ 50% (non-HF group) and 30 with LVEF ≤ 35% (HF group). Multiple high-density bi-atrial CFE maps were acquired along with AF cycle length (AFCL) at each procedural stage. Change in bi-atrial CFE areas, AFCL and outcome data were then compared. In the non-HF group, higher CFE-areas were found at baseline and at each step of the procedure in the LA. In both LA and the right atrium (RA), baseline and final CFE area were also higher in the non-HF group. Single procedure, arrhythmia-free survival at 1 year was higher in the HF group compared with the non-HF group (72% vs. 43%, log rank P = 0.04). Final total bi-atrial CFE area was an independent predictor of arrhythmia recurrence. Conclusions CFE represents an important surrogate marker of atrial substrate complexity. The atrial substrate in persistent AF differs between HF and non-HF with the latter representing a more complex 'primary' bi-atrial myopathy. LA focussed ablation results in more extensive substrate modification in HF and better clinical outcomes as compared with non-HF.
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Affiliation(s)
- Shouvik K Haldar
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - David G Jones
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Habib Khan
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Sandeep Panikker
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Julian W E Jarman
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Charlie Butcher
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Eric Lim
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Gareth Wynn
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Dhiraj Gupta
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK.,Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Wajid Hussain
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Vias Markides
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Tom Wong
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
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12
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Yin X, Zhao Z, Gao L, Chang D, Xiao X, Zhang R, Chen Q, Cheng J, Yang Y, Xi Y, Xia Y. Frequency Gradient Within Coronary Sinus Predicts the Long-Term Outcome of Persistent Atrial Fibrillation Catheter Ablation. J Am Heart Assoc 2017; 6:JAHA.116.004869. [PMID: 28255079 PMCID: PMC5524018 DOI: 10.1161/jaha.116.004869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background The coronary sinus (CS), as a junction of the atria, contributes to atrial fibrillation (AF) by developing unstable reentry, and isolating the atria by ablation at the CS could terminate AF. The present study evaluated whether AF activities at the CS in a subset of patients contributed to AF maintenance and predicted clinical outcome of ablation. Methods and Results We studied 122 consecutive patients who had a first‐time radiofrequency ablation for persistent AF. Bipolar electrograms were obtained from multiple regions of the left atrium by a Lasso mapping catheter before ablation. Pulmonary vein isolation terminated AF in 12 patients (9.8%). Sequential stepwise ablation was conducted in pulmonary vein isolation nontermination patients and succeeded in 22 patients (18%). In the stepwise termination group, AF frequency in the proximal CS (CSp) was significantly higher (10.2±2.1 Hz versus 8.3±1.8 Hz, P<0.001), and the ratio of distal CS (CSd) to proximal CS (CSd/CSp ratio, 56.6%±10.11% versus 70.7%±9.8%, P<0.001) was significantly lower than that in the nontermination group. The stepwise logistic regression analysis indicated that the CSd/CSp ratio was an independent predictor with an odds ratio of 1.131 (95%CI 1.053‐1.214; P=0.001). With a cutoff of 67%, the patients with lower CSd/CSp ratios had significantly better index and long‐term outcomes than those with higher ratios during a follow‐up of 46±18 months. Conclusions Rapid repetitive activities in the musculature of the proximal CS may contribute to maintenance of AF after pulmonary vein isolation alone in persistent AF. A cutoff at 67%, of the CSd/CSp frequency ratio might be an indicator to stratify the subset of patients who might benefit from CS ablation.
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Affiliation(s)
- Xiaomeng Yin
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Ziming Zhao
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Lianjun Gao
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Dong Chang
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xianjie Xiao
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Rongfeng Zhang
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Qi Chen
- Texas Heart Institute, Houston, TX
| | | | - Yanzong Yang
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yutao Xi
- Texas Heart Institute, Houston, TX
| | - Yunlong Xia
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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13
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Ciaccio EJ, Biviano AB, Iyer V, Garan H. Differences in continuous spectra of fractionated electrograms in paroxysmal versus persistent atrial fibrillation. Comput Biol Med 2016; 76:50-9. [DOI: 10.1016/j.compbiomed.2016.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/08/2016] [Accepted: 06/20/2016] [Indexed: 11/26/2022]
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14
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Kunamalla A, Ng J, Parini V, Yoo S, McGee KA, Tomson TT, Gordon D, Thorp EB, Lomasney J, Zhang Q, Shah S, Browne S, Knight BP, Passman R, Goldberger JJ, Aistrup G, Arora R. Constitutive Expression of a Dominant-Negative TGF-β Type II Receptor in the Posterior Left Atrium Leads to Beneficial Remodeling of Atrial Fibrillation Substrate. Circ Res 2016; 119:69-82. [PMID: 27217399 DOI: 10.1161/circresaha.115.307878] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/23/2016] [Indexed: 11/16/2022]
Abstract
RATIONALE Fibrosis is an important structural contributor to formation of atrial fibrillation (AF) substrate in heart failure. Transforming growth factor-β (TGF-β) signaling is thought to be intricately involved in creation of atrial fibrosis. OBJECTIVE We hypothesized that gene-based expression of dominant-negative type II TGF-β receptor (TGF-β-RII-DN) in the posterior left atrium in a canine heart failure model will sufficiently attenuate fibrosis-induced changes in atrial conduction and restitution to decrease AF. Because AF electrograms are thought to reflect AF substrate, we further hypothesized that TGF-β-RII-DN would lead to increased fractionation and decreased organization of AF electrograms. METHODS AND RESULTS Twenty-one dogs underwent injection+electroporation in the posterior left atrium of plasmid expressing a dominant-negative TGF-β type II receptor (pUBc-TGFβ-DN-RII; n=9) or control vector (pUBc-LacZ; n=12), followed by 3 to 4 weeks of right ventricular tachypacing (240 bpm). Compared with controls, dogs treated with pUBC-TGFβ-DN-RII demonstrated an attenuated increase in conduction inhomogeneity, flattening of restitution slope and decreased duration of induced AF, with AF electrograms being more fractionated and less organized in pUBc-TGFβ-DN-RII versus pUBc-LacZ dogs. Tissue analysis revealed a significant decrease in replacement/interstitial fibrosis, p-SMAD2/3 and p-ERK1/2. CONCLUSIONS Targeted gene-based reduction of TGF-β signaling in the posterior left atrium-with resulting decrease in replacement fibrosis-led to beneficial remodeling of both conduction and restitution characteristics of the posterior left atrium, translating into a decrease in AF and increased complexity of AF electrograms. In addition to providing mechanistic insights, this data may have important diagnostic and therapeutic implications for AF.
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Affiliation(s)
- Aaron Kunamalla
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Jason Ng
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Vamsi Parini
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Shin Yoo
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Kate A McGee
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Todd T Tomson
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - David Gordon
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Edward B Thorp
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Jon Lomasney
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Qiang Zhang
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Sanjiv Shah
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Suzanne Browne
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Bradley P Knight
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Rod Passman
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Jeffrey J Goldberger
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Gary Aistrup
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Rishi Arora
- From the Feinberg Cardiovascular Research Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL.
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15
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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.
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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
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16
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Tan TC, Koutsogeorgis ID, Grapsa J, Papadopoulos C, Katsivas A, Nihoyannopoulos P. Left atrium and the imaging of atrial fibrosis: catch it if you can! Eur J Clin Invest 2014; 44:872-81. [PMID: 25066356 DOI: 10.1111/eci.12305] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/23/2014] [Indexed: 01/04/2023]
Abstract
Atrial fibrillation is a sustained arrhythmia commonly encountered in clinical practice. It has a high prevalence among the elderly and contributes significantly to the global socio-economic burden. Among many risk factors predisposing to atrial fibrillation is left atrial remodelling and wall fibrosis. Frequently, pathological left atrial wall remodelling and fibrosis results in low atrial compliance and elastance significantly increase the risk of developing permanent atrial fibrillation. We reviewed all literature which employs imaging and left atrial fibrosis and we present all available imaging modalities. Current imaging tools may play a role in the detection of atrial fibrosis, hence providing valuable information for risk stratification and management of patients with atrial fibrillation.
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Affiliation(s)
- Timothy C Tan
- Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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17
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Abstract
Atrial fibrillation (AF) has been defined as the new cardiovascular "epidemic". Its prevalence is rising in developed countries, and the associated social and economic costs are high. In the last few years, there has been an increasing interest in understanding the mechanisms of AF and its management. New pharmacotherapies together with novel techniques for surgical and catheter treatment of AF have been developed, allowing the maintenance of sinus rhythm and the alleviation of symptoms in a large number of patients with AF. However, there are still some challenges that need to be addressed. This article gives an overview of the current state of the art on novel techniques for diagnosis and management of AF.
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18
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Ng J, Gordon D, Passman RS, Knight BP, Arora R, Goldberger JJ. Electrogram morphology recurrence patterns during atrial fibrillation. Heart Rhythm 2014; 11:2027-34. [PMID: 25101485 DOI: 10.1016/j.hrthm.2014.08.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Traditional mapping of atrial fibrillation (AF) is limited by changing electrogram morphologies and variable cycle lengths. OBJECTIVE We tested the hypothesis that morphology recurrence plot analysis would identify sites of stable and repeatable electrogram morphology patterns. METHODS AF electrograms recorded from left atrial (LA) and right atrial (RA) sites in 19 patients (10 men; mean age 59 ± 10 years) before AF ablation were analyzed. Morphology recurrence plots for each electrogram recording were created by cross-correlation of each automatically detected activation with every other activation in the recording. A recurrence percentage, the percentage of the most common morphology, and the mean cycle length of activations with the most recurrent morphology were computed. RESULTS The morphology recurrence plots commonly showed checkerboard patterns of alternating high and low cross-correlation values, indicating periodic recurrences in morphologies. The mean recurrence percentage for all sites and all patients was 38 ± 25%. The highest recurrence percentage per patient averaged 83 ± 17%. The highest recurrence percentage was located in the RA in 5 patients and in the LA in 14 patients. Patients with sites of shortest mean cycle length of activations with the most recurrent morphology in the LA and RA had ablation failure rates of 25% and 100%, respectively (hazard ratio 4.95; P = .05). CONCLUSION A new technique to characterize electrogram morphology recurrence demonstrated that there is a distribution of sites with high and low repeatability of electrogram morphologies. Sites with rapid activation of highly repetitive morphology patterns may be critical to sustaining AF. Further testing of this approach to map and ablate AF sources is warranted.
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Affiliation(s)
- Jason Ng
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - David Gordon
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rod S Passman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bradley P Knight
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rishi Arora
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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19
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Ciaccio EJ, Biviano AB, Gambhir A, Jacobson JT, Garan H. Temporal stability in the spectral representation of complex fractionated atrial electrograms. Pacing Clin Electrophysiol 2014; 37:79-89. [PMID: 24033806 PMCID: PMC4215802 DOI: 10.1111/pace.12245] [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: 05/20/2013] [Revised: 07/01/2013] [Accepted: 07/10/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although local electrograms during atrial fibrillation (AF) are often spectrally analyzed over 8-second (8s) intervals, changes may be common over intervals as short as 2s. We sought to determine whether averaged 2s measurements of electrogram spectral parameters were similar to 8s measurements, and whether the 2s intervals could provide an estimate of the temporal stability of the signal frequency content in paroxysmal versus persistent AF. METHODS Complex fractionated atrial electrograms (CFAEs) were acquired outside the pulmonary vein ostia and from free wall sites in nine paroxysmal and 10 longstanding persistent AF patients. Using a 2s sliding calculation window, a frequency spectrum was computed every 100 ms over an interval of 8.4 seconds (82 spectra in total). The dominant frequency (DF), the dominant amplitude (DA), and the mean spectral profile (MP) were measured. The 2s measurements were compared to single 8.4-second interval measurements. Coefficients of variation (COV) were computed from the 82 spectra for each CFAE recording to determine temporal variability of parameters. RESULTS Over the sliding 2s computation intervals, as for fixed 8.4-second computation intervals, mean DA and DF were significantly higher in longstanding persistent AF while MP was significantly higher in paroxysmal AF (P ≤ 0.001). The COV was significantly higher for the DF parameter in paroxysmal AF (P < 0.001) and significantly higher for the MP parameter in persistent AF (P < 0.02). CONCLUSIONS For both paroxysmal and persistent AF data, the 2s sliding window averages provide similar results to single 8.4-second intervals, and information regarding temporal stability was additionally obtained in the process.
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Affiliation(s)
- Edward J Ciaccio
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
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20
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Ciaccio EJ, Biviano AB, Garan H. The dominant morphology of fractionated atrial electrograms has greater temporal stability in persistent as compared with paroxysmal atrial fibrillation. Comput Biol Med 2013; 43:2127-35. [PMID: 24290930 DOI: 10.1016/j.compbiomed.2013.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 08/03/2013] [Accepted: 08/16/2013] [Indexed: 10/26/2022]
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21
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CASTELLS FRANCISCO, CERVIGÓN RAQUEL, MILLET JOSÉ. On the Preprocessing of Atrial Electrograms in Atrial Fibrillation: Understanding Botteron's Approach. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:133-43. [DOI: 10.1111/pace.12288] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/20/2013] [Accepted: 08/14/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - RAQUEL CERVIGÓN
- Escuela Politécnica de Cuenca; Universidad de Castilla la Mancha; Cuenca Spain
| | - JOSÉ MILLET
- ITACA Institute; Universitat Politècnica de València; València Spain
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22
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Lau DH, Zeemering S, Maesen B, Kuklik P, Verheule S, Schotten U. Catheter Ablation Targeting Complex Fractionated Atrial Electrogram in Atrial Fibrillation. J Atr Fibrillation 2013; 6:907. [PMID: 28496893 PMCID: PMC5153035 DOI: 10.4022/jafib.907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 10/08/2013] [Accepted: 10/15/2013] [Indexed: 11/10/2022]
Abstract
The relatively low success rates seen with pulmonary vein ablation in non-paroxysmal atrial fibrillation (AF) patients as compared to those with the paroxysmal form of the arrhythmia have prompted electrophysiologists to search for newer ablative strategies. A decade has passed since the initial description of complex fractionated atrial electrogram (CFAE) ablation aimed at targeting the electrophysiological substrate in atrial fibrillation. Despite intensive research, superiority of CFAE-based ablation over other contemporary approaches could not be demonstrated. Nevertheless, the technique has an adjunctive role to pulmonary vein ablation in non-paroxysmal AF patients. Perhaps our incomplete understanding of the complex AF pathophysiology and inadequate characterization or determination of CFAE has limited our success so far. This review aims to highlight the current challenges and future role of CFAE ablation. .
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Affiliation(s)
- Dennis H Lau
- Department of Physiology, Maastricht University,Medical Center; Maastricht, The Netherlands
| | - Stef Zeemering
- Department of Physiology, Maastricht University,Medical Center; Maastricht, The Netherlands
| | - Bart Maesen
- Department of Physiology, Maastricht University,Medical Center; Maastricht, The Netherlands
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Center; Maastricht, The Netherlands
| | - Pawel Kuklik
- Department of Physiology, Maastricht University,Medical Center; Maastricht, The Netherlands
| | - Sander Verheule
- Department of Physiology, Maastricht University,Medical Center; Maastricht, The Netherlands
| | - Ulrich Schotten
- Department of Physiology, Maastricht University,Medical Center; Maastricht, The Netherlands
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23
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Computational method for high resolution spectral analysis of fractionated atrial electrograms. Comput Biol Med 2013; 43:1573-82. [PMID: 24034749 DOI: 10.1016/j.compbiomed.2013.07.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 07/11/2013] [Accepted: 07/16/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND The discrete Fourier transform (DFT) is often used as a spectral estimator for analysis of complex fractionated atrial electrograms (CFAE) acquired during atrial fibrillation (AF). However, time resolution can be unsatisfactory, as the frequency resolution is proportional to rate/time interval. In this study we compared the DFT to a new spectral estimator with improved time-frequency resolution. METHOD Recently, a novel spectral estimator (NSE) based upon signal averaging was derived and implemented computationally. The NSE is similar to the DFT in that both estimators model the autocorrelation function to form the power spectrum. However, as derived in this study, NSE frequency resolution is proportional to rate/period(2) and thus unlike the DFT, is not directly dependent on the window length. We hypothesized that the NSE would provide improved time resolution while maintaining satisfactory frequency resolution for computation of CFAE spectral parameters. Window lengths of 8s, 4s, 2s, 1s, and 0.5s were used for analysis. Two criteria gauged estimator performance. Firstly, a periodic electrogram pattern with phase jitter was embedded in interference. The error in detecting the frequency of the periodic pattern was determined. Secondly, significant differences in spectral parameters for paroxysmal versus persistent AF data, which have known dissimilarities, were determined using the DFT versus NSE methods. The parameters measured were the dominant amplitude, dominant frequency, and mean spectral profile. RESULTS At all time resolutions, the error in detecting the frequency of the repeating electrogram pattern was less for NSE than for DFT (p<0.001). The DFT was accurate to 2s time resolution/0.5 Hz frequency resolution, while the NSE was accurate to 0.5s time resolution/0.05 Hz frequency resolution. At all time resolutions, significant differences in the dominant amplitude spectral parameter for paroxysmal versus persistent CFAE were greater using NSE than DFT (p<0.0001). For three of five time resolutions, the NSE had greater significant differences than DFT for discriminating the dominant frequency and mean spectral profile parameters between AF types. CONCLUSIONS The results suggest that the NSE has improved performance versus DFT for measurement of CFAE spectral properties.
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Biviano AB, Ciaccio EJ, Gabelman T, Whang W, Garan H. Ibutilide increases the variability and complexity of atrial fibrillation electrograms: antiarrhythmic insights using signal analyses. Pacing Clin Electrophysiol 2013; 36:1228-35. [PMID: 23875908 DOI: 10.1111/pace.12224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 05/06/2013] [Accepted: 06/03/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Intravenous ibutilide is used to convert atrial fibrillation (AF) to sinus rhythm (SR) due to its Class III antiarrhythmic mechanisms. However, the effects of ibutilide on local electrograms (EGMs) during AF have not been elucidated. METHODS AND RESULTS We used EGM analysis techniques to characterize how ibutilide administration changes the frequency, morphology, and repeatability of AF EGM signals, thereby providing insight into ibutilide's antiarrhythmic mechanism of action. AF recordings were collected from 21 patients with AF, both before and after ibutilide administration. The effects of ibutilide on the following AF EGM parameters were assessed: (1) dominant frequency (DF), (2) variations in EGM amplitude and overall morphology, (3) repetition of EGM patterns, and (4) complexity of the AF frequency spectra. When comparing pre- versus post-ibutilide administration EGMs, DF decreased from 5.45 Hz to 4.02 Hz (P < 0.0001). There was an increase in the variability of both AF EGM amplitudes (P = 0.003) and overall AF EGM morphologies (P = 0.003). AF EGM pattern repetitiveness decreased (P = 0.01), and the AF frequency spectral profile manifested greater complexity (P = 0.02). CONCLUSIONS Novel EGM signal analysis techniques reveal that ibutilide administration causes increased complexity in the atrial electrical activation pattern with decreasing rate. These findings may be explained by the progressive destabilization of higher frequency, more homogeneous primary drivers of AF over the course of ibutilide administration, and/or less uniform propagation of atrial activation, until AF maintenance becomes more difficult and either transforms to atrial tachycardia or terminates to SR.
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Affiliation(s)
- Angelo B Biviano
- Cardiology Division, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Newyork-Presbyterian Hospital, Columbia University Medical Center, New York, New York
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Dosdall DJ, Ranjan R, Higuchi K, Kholmovski E, Angel N, Li L, Macleod R, Norlund L, Olsen A, Davies CJ, Marrouche NF. Chronic atrial fibrillation causes left ventricular dysfunction in dogs but not goats: experience with dogs, goats, and pigs. Am J Physiol Heart Circ Physiol 2013; 305:H725-31. [PMID: 23812387 DOI: 10.1152/ajpheart.00440.2013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Structural remodeling in chronic atrial fibrillation (AF) occurs over weeks to months. To study the electrophysiological, structural, and functional changes that occur in chronic AF, the selection of the best animal model is critical. AF was induced by rapid atrial pacing (50-Hz stimulation every other second) in pigs (n = 4), dogs (n = 8), and goats (n = 9). Animals underwent MRIs at baseline and 6 mo to evaluate left ventricular (LV) ejection fraction (EF). Dogs were given metoprolol (50-100 mg po bid) and digoxin (0.0625-0.125 mg po bid) to limit the ventricular response rate to <180 beats/min and to mitigate the effects of heart failure. The pacing leads in pigs became entirely encapsulated and lost the ability to excite the heart, often before the onset of sustained AF. LV EF in dogs dropped from 54 ± 11% at baseline to 33 ± 7% at 6 mo (P < 0.05), whereas LV EF in goats did not drop significantly (69 ± 8% at baseline vs. 60 ± 9% at 6 mo, P = not significant). After 6 mo of AF, fibrosis levels in dog atria and ventricles increased, whereas only atrial fibrosis levels increased in goats compared with control animals. In our experience, the pig model is not appropriate for chronic rapid atrial pacing-induced AF studies. Rate-controlled chronic AF in the dog model developed HF and LV fibrosis, whereas the goat model developed only atrial fibrosis without ventricular dysfunction and fibrosis. Both the dog and goat models are representative of segments of the patient population with chronic AF.
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Affiliation(s)
- Derek J Dosdall
- Comprehensive Arrhythmia Research and Management Center, University of Utah, Salt Lake City, Utah; and
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Pantos I, Katritsis G, Zografos T, Camm AJ, Katritsis DG. Temporal stability of atrial electrogram fractionation in patients with paroxysmal atrial fibrillation. Am J Cardiol 2013; 111:863-8. [PMID: 23276474 DOI: 10.1016/j.amjcard.2012.11.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 11/27/2012] [Accepted: 11/27/2012] [Indexed: 11/19/2022]
Abstract
The atrial sites associated with fractionated activity and/or high-frequency signals are commonly considered as targets of ablation for atrial fibrillation (AF); however, their temporal stability has not been established. A total of 21 patients with paroxysmal AF were studied. Left atrial (LA) ganglionated plexi (GP) were identified by high-frequency stimulation, and prolonged (3-minute) electrogram sampling from the GP and the posterior wall of the left atrium during AF was acquired. Fast Fourier transformation was used to determine the dominant frequencies (DFs) of the recorded electrogram signals and to study their temporal variability. The DF at the identified GP was 5.34 ± 0.78 Hz and at the posterior LA wall was 5.58 ± 0.87 Hz. Fractionation, expressed as electrograms exhibiting consecutive DFs deferring >20%, was detected at 21 of the studied GP (84%) and 7 of the posterior LA wall sites (44%). Fractionation, expressed as electrograms exhibiting DFs >8 Hz, was detected at 6 GP (24%) and 1 posterior LA wall site (6%). During the 3-minute recordings, the derived DFs were temporally variable, exhibiting an average coefficient of variation of 15.2 ± 12.0%. Fractionation, expressed by significant consecutive DF variability (>20%), was detected only for 18.0 ± 19.0% of the recording period at GP and for 12.7 ± 13.4% at the posterior LA wall. In conclusion, atrial electrograms are temporarily variable, and fractionation is transient at atrial sites associated with fractionated electrical activity during AF. Our results question the clinical validity of fractionated atrial electrograms for ablation purposes.
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Viles-Gonzalez JF, Gomes JA, Miller MA, Dukkipati SR, Koruth JS, Eggert C, Coffey J, Reddy VY, d'Avila A. Areas with complex fractionated atrial electrograms recorded after pulmonary vein isolation represent normal voltage and conduction velocity in sinus rhythm. ACTA ACUST UNITED AC 2012; 15:339-46. [PMID: 23148118 DOI: 10.1093/europace/eus321] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Juan F Viles-Gonzalez
- Helmsley Electrophysiology Center, Mount Sinai Heart, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York City, NY 10029, USA
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Lin YJ, Suenari K, Lo MT, Lin C, Hsieh WH, Chang SL, Lo LW, Hu YF, Cheng CC, Kihara Y, Chao TF, Hartono B, Wu TJ, Lin WS, Hsu KH, Kibos AS, Huang NE, Chen SA. Novel Assessment of Temporal Variation in Fractionated Electrograms Using Histogram Analysis of Local Fractionation Interval in Patients With Persistent Atrial Fibrillation. Circ Arrhythm Electrophysiol 2012; 5:949-56. [DOI: 10.1161/circep.111.967612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yenn-Jiang Lin
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Kazuyoshi Suenari
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Men-Tzung Lo
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Chen Lin
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Wan-Hsin Hsieh
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Shih-Lin Chang
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Li-Wei Lo
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Yu-Feng Hu
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Chen-Chuan Cheng
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Yasuki Kihara
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Tze-Fan Chao
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Beny Hartono
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Tsu-Juey Wu
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Wei-Shiang Lin
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Ke-Hsin Hsu
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Ambrose S. Kibos
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Norden E. Huang
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
| | - Shih-Ann Chen
- From the Division of Cardiology, Taipei Veterans General Hospital (Y.-J. L., K.S., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., B.H., A.S.K., S.-A.C.), Taipei, Taiwan; School of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University (Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-F.C., T.-J.W., S.-A.C.), Taipei, Taiwan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences (K.S., Y.K.), Hiroshima, Japan; Research Center for
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Caldwell J, Redfearn D. Ablation of complex fractionated atrial electrograms in catheter ablation for AF; where have we been and where are we going? Curr Cardiol Rev 2012; 8:347-53. [PMID: 22920481 PMCID: PMC3492817 DOI: 10.2174/157340312803760848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 06/25/2012] [Accepted: 07/16/2012] [Indexed: 11/22/2022] Open
Abstract
Catheter ablation for persistent AF remains a challenge to the ablator as the disease is now outside the veins and cannot be tackled by pulmonary vein isolation alone. In this article we describe targeting complex fractionated atrial electrograms (CFAE) as a method to guide atrial substrate modification.
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Affiliation(s)
- Jane Caldwell
- Arrhythmia Service, Division of Cardiology, Kingston General Hospital, Queen's University, 76 Stuart St, Kingston, Ontario, Canada
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Koduri H, Ng J, Cokic I, Aistrup GL, Gordon D, Wasserstrom JA, Kadish AH, Lee R, Passman R, Knight BP, Goldberger JJ, Arora R. Contribution of fibrosis and the autonomic nervous system to atrial fibrillation electrograms in heart failure. Circ Arrhythm Electrophysiol 2012; 5:640-9. [PMID: 22722658 DOI: 10.1161/circep.111.970095] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Fibrotic and autonomic remodeling in heart failure (HF) increase vulnerability to atrial fibrillation (AF). Because AF electrograms (EGMs) are thought to reflect the underlying structural substrate, we sought to (1) determine the differences in AF EGMs in normal versus HF atria and (2) assess how fibrosis and nerve-rich fat contribute to AF EGM characteristics in HF. METHODS AND RESULTS AF was induced in 20 normal dogs by vagal stimulation and in 21 HF dogs (subjected to 3 weeks of rapid ventricular pacing at 240 beats per minute). AF EGMs were analyzed for dominant frequency (DF), organization index, fractionation intervals (FIs), and Shannon entropy. In 8 HF dogs, AF EGM correlation with underlying fibrosis/fat/nerves was assessed. In HF compared with normal dogs, DF was lower and organization index/FI/Shannon entropy were greater. DF/FI were more heterogeneous in HF. Percentage fat was greater, and fibrosis and fat were more heterogeneously distributed in the posterior left atrium than in the left atrial appendage. DF/organization index correlated closely with %fibrosis. Heterogeneity of DF/FI correlated with the heterogeneity of fibrosis. Autonomic blockade caused a greater change in DF/FI/Shannon entropy in the posterior left atrium than left atrial appendage, with the decrease in Shannon entropy correlating with %fat. CONCLUSIONS The amount and distribution of fibrosis in the HF atrium seems to contribute to slowing and increased organization of AF EGMs, whereas the nerve-rich fat in the HF posterior left atrium is positively correlated with AF EGM entropy. By allowing for improved detection of regions of dense fibrosis and high autonomic nerve density in the HF atrium, these findings may help enhance the precision and success of substrate-guided ablation for AF.
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Affiliation(s)
- Hemantha Koduri
- Feinberg Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Northwestern University-Feinberg School of Medicine, Chicago, IL 60611, USA
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Ciaccio EJ, Biviano AB, Whang W, Gambhir A, Garan H. Spectral profiles of complex fractionated atrial electrograms are different in longstanding and acute onset atrial fibrillation atrial electrogram spectra. J Cardiovasc Electrophysiol 2012; 23:971-9. [PMID: 22578068 DOI: 10.1111/j.1540-8167.2012.02349.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Spectral Profiles of CFAE. BACKGROUND Spectral analysis of complex fractionated atrial electrograms (CFAE) may be useful for gaining insight into mechanisms underlying paroxysmal and longstanding atrial fibrillation (AF). The commonly used dominant frequency (DF) measurement has limitations. METHOD CFAE recordings were acquired from outside the 4 pulmonary vein ostia and at 2 left atrial free wall sites in 10 paroxysmal and 10 persistent AF patients. Two consecutive 8s-series were analyzed from recordings >16s in duration. Power spectra were computed for each 8s-series in the range 3-12 Hz and normalized. The mean and standard deviation of normalized power spectra (MPS and SPS, respectively) were compared for paroxysmal versus persistent CFAE. Also, the DF and its peak amplitude (ADF) were compared for pulmonary vein sites only. Power spectra were computed using ensemble average and Fourier methods. RESULTS No significant changes occurred in any parameter from the first to second recording sequence. For both sequences, MPS and SPS were significantly greater, and DF and ADF were significantly less, in paroxysmals versus persistents. The MPS and ADF measurements from ensemble spectra produced the most significant differences in paroxysmals versus persistents (P < 0.0001). DF differences were less significant, which can be attributed to the relatively high variability of DF in paroxysmals. The MPS was correlated to the duration of uninterrupted persistent AF prior to electrophysiologic study (P = 0.01), and to left atrial volume for all AF (P < 0.05). CONCLUSIONS The MPS and ADF measurements introduced in this study are probably superior to DF for discerning power spectral differences in paroxysmal versus longstanding CFAE. (J Cardiovasc Electrophysiol, Vol. 23, pp. 971-979, September 2012).
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Affiliation(s)
- Edward J Ciaccio
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.
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Lau DH, Maesen B, Zeemering S, Verheule S, Crijns HJ, Schotten U. Stability of Complex Fractionated Atrial Electrograms: A Systematic Review. J Cardiovasc Electrophysiol 2012; 23:980-7. [PMID: 22554025 DOI: 10.1111/j.1540-8167.2012.02335.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Dennis H Lau
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
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Ciaccio EJ, Biviano AB, Whang W, Garan H. A new LMS algorithm for analysis of atrial fibrillation signals. Biomed Eng Online 2012; 11:15. [PMID: 22449196 PMCID: PMC3442996 DOI: 10.1186/1475-925x-11-15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 03/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A biomedical signal can be defined by its extrinsic features (x-axis and y-axis shift and scale) and intrinsic features (shape after normalization of extrinsic features). In this study, an LMS algorithm utilizing the method of differential steepest descent is developed, and is tested by normalization of extrinsic features in complex fractionated atrial electrograms (CFAE). METHOD Equations for normalization of x-axis and y-axis shift and scale are first derived. The algorithm is implemented for real-time analysis of CFAE acquired during atrial fibrillation (AF). Data was acquired at a 977 Hz sampling rate from 10 paroxysmal and 10 persistent AF patients undergoing clinical electrophysiologic study and catheter ablation therapy. Over 24 trials, normalization characteristics using the new algorithm with four weights were compared to the Widrow-Hoff LMS algorithm with four tapped delays. The time for convergence, and the mean squared error (MSE) after convergence, were compared. The new LMS algorithm was also applied to lead aVF of the electrocardiogram in one patient with longstanding persistent AF, to enhance the F wave and to monitor extrinsic changes in signal shape. The average waveform over a 25 s interval was used as a prototypical reference signal for matching with the aVF lead. RESULTS Based on the derivation equations, the y-shift and y-scale adjustments of the new LMS algorithm were shown to be equivalent to the scalar form of the Widrow-Hoff LMS algorithm. For x-shift and x-scale adjustments, rather than implementing a long tapped delay as in Widrow-Hoff LMS, the new method uses only two weights. After convergence, the MSE for matching paroxysmal CFAE averaged 0.46 ± 0.49 μV(2)/sample for the new LMS algorithm versus 0.72 ± 0.35 μV(2)/sample for Widrow-Hoff LMS. The MSE for matching persistent CFAE averaged 0.55 ± 0.95 μV(2)/sample for the new LMS algorithm versus 0.62 ± 0.55 μV(2)/sample for Widrow-Hoff LMS. There were no significant differences in estimation error for paroxysmal versus persistent data. From all trials, the mean convergence time was approximately 1 second for both algorithms. The new LMS algorithm was useful to enhance the electrocardiogram F wave by subtraction of an adaptively weighted prototypical reference signal from the aVF lead. The extrinsic weighting over 25 s demonstrated that time-varying functions such as patient respiration could be identified and monitored. CONCLUSIONS A new LMS algorithm was derived and used for normalization of the extrinsic features in CFAE and for electrocardiogram monitoring. The weighting at convergence provides an estimate of the degree of similarity between two signals in terms of x-axis and y-axis shift and scale. The algorithm is computationally efficient with low estimation error. Based on the results, proposed applications include monitoring of extrinsic and intrinsic features of repetitive patterns in CFAE, enhancement of the electrocardiogram F wave and monitoring of time-varying signal properties, and to quantitatively characterize mechanistic differences in paroxysmal versus persistent AF.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, USA.
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Ciaccio EJ, Biviano AB, Whang W, Garan H. Identification of recurring patterns in fractionated atrial electrograms using new transform coefficients. Biomed Eng Online 2012; 11:4. [PMID: 22260298 PMCID: PMC3390903 DOI: 10.1186/1475-925x-11-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 01/19/2012] [Indexed: 11/21/2022] Open
Abstract
Background Identification of recurrent patterns in complex fractionated atrial electrograms (CFAE) has been used to differentiate paroxysmal from persistent atrial fibrillation (AF). Detection of the atrial CFAE patterns might therefore be assistive in guiding radiofrequency catheter ablation to drivers of the arrhythmia. In this study a technique for robust detection and classification of recurrent CFAE patterns is described. Method CFAE were obtained from the four pulmonary vein ostia, and from the anterior and posterior left atrium, in 10 patients with paroxysmal AF and 10 patients with longstanding persistent AF (216 recordings in total). Sequences 8.4 s in length were analyzed (8,192 sample points, 977 Hz sampling). Among the 216 sequences, two recurrent patterns A and B were substituted for 4 and 5 of the sequences, respectively. To this data, random interference, and random interference + noise were separately added. Basis vectors were constructed using a new transform that is derived from ensemble averaging. Patterns A and B were then detected and classified using a threshold level of Euclidean distance between spectral signatures as constructed with transform coefficients. Results In the presence of interference, sensitivity to detect and distinguish two patterns A and B was 96.2%, while specificity to exclude nonpatterns was 98.0%. In the presence of interference + noise, sensitivity was 89.1% while specificity was 97.0%. Conclusions Transform coefficients computed from ensemble averages can be used to succinctly quantify synchronized patterns present in AF data. The technique is useful to automatically detect recurrent patterns in CFAE that are embedded in interference without user bias. This quantitation can be implemented in real-time to map the AF substrate prior to and during catheter ablation.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine - Division of Cardiology, Columbia University Medical Center, Columbia University, New York, NY 10032, USA.
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Berenfeld O, Jalife J. Complex fractionated atrial electrograms: is this the beast to tame in atrial fibrillation? Circ Arrhythm Electrophysiol 2011; 4:426-8. [PMID: 21846887 DOI: 10.1161/circep.111.964841] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ciaccio EJ, Biviano AB, Whang W, Coromilas J, Garan H. A new transform for the analysis of complex fractionated atrial electrograms. Biomed Eng Online 2011; 10:35. [PMID: 21569421 PMCID: PMC3125385 DOI: 10.1186/1475-925x-10-35] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 05/12/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Representation of independent biophysical sources using Fourier analysis can be inefficient because the basis is sinusoidal and general. When complex fractionated atrial electrograms (CFAE) are acquired during atrial fibrillation (AF), the electrogram morphology depends on the mix of distinct nonsinusoidal generators. Identification of these generators using efficient methods of representation and comparison would be useful for targeting catheter ablation sites to prevent arrhythmia reinduction. METHOD A data-driven basis and transform is described which utilizes the ensemble average of signal segments to identify and distinguish CFAE morphologic components and frequencies. Calculation of the dominant frequency (DF) of actual CFAE, and identification of simulated independent generator frequencies and morphologies embedded in CFAE, is done using a total of 216 recordings from 10 paroxysmal and 10 persistent AF patients. The transform is tested versus Fourier analysis to detect spectral components in the presence of phase noise and interference. Correspondence is shown between ensemble basis vectors of highest power and corresponding synthetic drivers embedded in CFAE. RESULTS The ensemble basis is orthogonal, and efficient for representation of CFAE components as compared with Fourier analysis (p ≤ 0.002). When three synthetic drivers with additive phase noise and interference were decomposed, the top three peaks in the ensemble power spectrum corresponded to the driver frequencies more closely as compared with top Fourier power spectrum peaks (p ≤ 0.005). The synthesized drivers with phase noise and interference were extractable from their corresponding ensemble basis with a mean error of less than 10%. CONCLUSIONS The new transform is able to efficiently identify CFAE features using DF calculation and by discerning morphologic differences. Unlike the Fourier transform method, it does not distort CFAE signals prior to analysis, and is relatively robust to jitter in periodic events. Thus the ensemble method can provide a useful alternative for quantitative characterization of CFAE during clinical study.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University, USA
| | - Angelo B Biviano
- Department of Medicine, Division of Cardiology, Columbia University, USA
| | - William Whang
- Department of Medicine, Division of Cardiology, Columbia University, USA
| | - James Coromilas
- Department of Medicine, University of Medicine and Dentistry of New Jersey, USA
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University, USA
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