Characteristics of atrial fibrillation cycle length predict restoration of sinus rhythm by catheter ablation

Marco, Luigi Yuri Di; Raine, Daniel; Bourke, John; Langley, Philip

doi:10.1016/j.hrthm.2013.06.007

Cited by 27 publications

(17 citation statements)

References 19 publications

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“…Prior study has shown that AF recurrence and stability, as well as higher measures of frequency organization, have been shown to correlate with AF termination during ablation, and after antiarrhythmic medication treatment. 21–23 In addition, EGM recurrence patterns, as measured by morphology recurrence plot analysis, have more recently been postulated to be critical for sustaining AF. 24, 25 Thus, the search for other EGM indices as tools for finding ablation targets continues, and further analysis is required to understand the significance of these differences and to define their role during ablation procedures.…”

Section: Discussionmentioning

confidence: 99%

Atrial electrogram discordance during baseline vs reinduced atrial fibrillation: Potential ramifications for ablation procedures

et al. 2015

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Background There are scant data comparing the electrogram (EGM) signal characteristics of AF in the baseline versus 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 re-induction on AF EGMs in patients with persistent AF. Methods We collected left atrial EGMs in patients undergoing first ablation for persistent AF at three time intervals: i) AF at baseline; ii) AF after pulmonary vein isolation (PVI) and; iii) AF after post-PVI cardioversion and subsequent re-induction. We analyzed the following two EGM spectral characteristics: 1a) dominant frequency (DF) and 1b) spectral complexity; and the following two EGM morphologic characteristics: 2a) morphology variation, and 2b) pattern repetitiveness. Results There were no differences in AF dominant frequency, dominant amplitude, spectral complexity, or metrics of EGM morphology or repetitiveness at baseline versus after PVI. However, dominant frequency, dominant amplitude, and spectral complexity differed significantly after DC cardioversion and re-induction of AF. Conclusions The frequency, spectral complexity and local EGM morphologies of AF do not significantly change over the course of a pulmonary vein isolation procedure in patients with persistent AF. However, re-induction of AF after DC cardioversion results in different DF 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 versus re-induced AF, with potential clinical ramifications for outcomes of catheter ablation procedures.

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Section: Discussionmentioning

confidence: 99%

Atrial electrogram discordance during baseline vs reinduced atrial fibrillation: Potential ramifications for ablation procedures

et al. 2015

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“…In 1 study, stability of the frequency spectrum predicted AF termination during the ablation and freedom of atrial arrhythmias after a limited follow-up of 3 months. 25 SampEn has not been used to predict ablation outcome before. In our study, SampEn showed a low predictive value.…”

Section: Lead I) Ecg Complexity Predicts Outcome Of Ablation For Afmentioning

confidence: 99%

Atrial Fibrillation Complexity Parameters Derived From Surface ECGs Predict Procedural Outcome and Long-Term Follow-Up of Stepwise Catheter Ablation for Atrial Fibrillation

Lankveld

Zeemering

Scherr

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-The success rate of catheter ablation for persistent atrial fibrillation (AF) is still far from satisfactory.Identification of patients who will benefit from ablation is highly desirable. We investigated the predictive value of noninvasive AF complexity parameters derived from standard 12-lead ECGs for AF termination and long-term success of catheter ablation and compared them with clinical predictors. Methods and Results-The study included a training (93 patients) and a validation set (81 patients) of patients with persistent AF undergoing stepwise radiofrequency ablation. In the training set AF terminated in 81% during catheter ablation, 77% were in sinus rhythm after 6 years and multiple ablations. ECG-derived complexity parameters were determined from a baseline 10-s 12-lead ECG. Prediction of AF termination was similar using only ECG (cross-validated mean area under the curve [AUC], 0.76±0.15) or only clinical parameters (mean AUC, 0.75±0.16). The combination improved prediction to a mean AUC of 0.79±0.13. Using a combined model of ECG and clinical parameters, sinus rhythm at long-term follow-up could be predicted with a mean AUC of 0.71±0.12. In the validation set AF terminated in 57%, 61% were in sinus rhythm after 4.6 years. The combined models predicted termination with an AUC of 0.70 and sinus rhythm at longterm follow-up with an AUC of 0.61. Overall, fibrillation-wave amplitude provided the best rhythm prediction. Conclusions-The predictive performance of ECG-derived AF complexity parameters for AF termination and long-term success of catheter ablation in patients with persistent AF is at least as good as known clinical predictive parameters, with fibrillation-wave amplitude as the best predictor. (Circ Arrhythm Electrophysiol. 2016;9:e003354.

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“…Analyses of intracardiac EGMs suggest that RQA may characterize underlying AF organization while identifying local areas that may be drivers of AF . Furthermore, RQA parameters have been shown to discriminate among paroxysmal, persistent, and induced AF, predict spontaneous termination of AF, and predict long‐term catheter ablation outcomes …”

Section: Introductionmentioning

confidence: 99%

“…These measures have been associated with organization and termination of AF following antiarrhythmic therapy and step-wise catheter ablation. [8][9][10][11] While frequency domain analysis primarily describes temporal patterns of atrial activation, recurrence quantification analysis (RQA) techniques describe both morphologic [12][13][14][15] and temporal 16,17 stability of AF on the surface electrocardiogram, intracardiac EGMs, and epicardial EGMs. Analyses of intracardiac EGMs suggest that RQA may characterize underlying AF organization 15 while identifying local areas that may be drivers of AF.…”

Section: Introductionmentioning

confidence: 99%

“…13 Furthermore, RQA parameters have been shown to discriminate among paroxysmal, persistent, and induced AF, 12 predict spontaneous termination of AF, 18 and predict long-term catheter ablation outcomes. 17 The goal of this analysis was to test the hypothesis that FIRM ablation results in quantifiable temporal and morphologic organization of AF as measured by frequency domain analysis and RQA of coronary sinus EGMs following FIRM ablation.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Focal impulse and rotor modulation of atrial rotors during atrial fibrillation leads to organization of left atrial activation as reflected by waveform morphology recurrence quantification analysis and organizational index

Liu

Friedman

Barnett

et al. 2020

Journal of Arrhythmia

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Background Focal impulse and rotor modulation (FIRM) can cause slowing, organization, and occasionally termination of atrial fibrillation (AF), although results have been mixed. To further characterize changes in AF during rotor ablation, we quantified morphologic and temporal activation changes following FIRM. Methods In patients undergoing FIRM ablation for AF, we retrospectively analyzed coronary sinus bipolar EGMs before and after rotor ablation, including EGM activation frequency and regularity, dominant frequency (DF), and organizational index (OI). Changes in EGM waveform morphology were determined with recurrence quantification analysis (RQA) consisting of recurrence rate (RR), determinism (DET), laminarity (LAM), average diagonal line length (L), and trapping time (TT) using Wilcoxon signed‐rank testing. Results Overall, 36 rotors from 21 patients undergoing FIRM ablation were analyzed. All morphology RQA parameters demonstrated significant organization of atrial activation after rotor ablation (RR P = .03, DET P = .005, LAM P = .03, L P = .005, TT P = .009). The organizational index also showed a significant increase after rotor ablation (P = .01), and the change in OI correlated with changes in all morphology parameters. Of the rotors, 14/36 (39%) rotors showed organizational changes in all morphology parameters and OI, and an additional 5 rotors (19/36, 53%) showed organizational changes in 4 of 5 morphology parameters and OI. Conclusions Coronary sinus EGM waveform morphologies and activation patterns are significantly altered after FIRM ablation even when there is no fibrillatory slowing. RQA morphology analysis and organizational index may impart important information regarding underlying AF organization and may be useful in quantifying the acute response to ablation.

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Characteristics of atrial fibrillation cycle length predict restoration of sinus rhythm by catheter ablation

Cited by 27 publications

References 19 publications

Atrial electrogram discordance during baseline vs reinduced atrial fibrillation: Potential ramifications for ablation procedures

Atrial electrogram discordance during baseline vs reinduced atrial fibrillation: Potential ramifications for ablation procedures

Atrial Fibrillation Complexity Parameters Derived From Surface ECGs Predict Procedural Outcome and Long-Term Follow-Up of Stepwise Catheter Ablation for Atrial Fibrillation

Focal impulse and rotor modulation of atrial rotors during atrial fibrillation leads to organization of left atrial activation as reflected by waveform morphology recurrence quantification analysis and organizational index

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