Clinical Role of Dominant Frequency Measurements in Atrial Fibrillation Ablation – A Systematic Review

Gadenz, Lucaz; Hashemi, Javad; Shariat, Mohammad Hassan; Gula, Lorne J.; Redfearn, Damián P.

doi:10.4022/jafib.1548

Cited by 15 publications

(10 citation statements)

References 31 publications

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“…This notion led to hypothesis that ablating DF sites might be a valid target for AF ablation (Mandapati et al, 2000 ; Sanders et al, 2005 ). Indeed, the presence of high frequency sites inversely correlated to procedural success rates (Gadenz et al, 2017 ; Kimata et al, 2018 ) but targeting DF sites did not consistently lead to improvement of clinical outcome (Atienza et al, 2014 ; Gadenz et al, 2017 ). It is unclear whether these negative outcomes entail that CFAE and high DF indicate bystander sites instead of AF driver sites or are due to technical limitations of the methods applied.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike such electrogram parameters, with focal impulse and rotor mapping (FIRM) conduction patterns are identified that putatively describe focal and rotational activity. Narayan et al ( 2012 ); Swarup et al ( 2014 ) Unfortunately, targeting these substrate parameters has variable outcomes in clinical trials and need further validation (Gadenz et al, 2017 ; Krummen et al, 2017 ; van der Does and de Groot, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

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Stationary Atrial Fibrillation Properties in the Goat Do Not Entail Stable or Recurrent Conduction Patterns

et al. 2018

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Introduction: Electro-anatomical mapping of the atria is used to identify the substrate of atrial fibrillation (AF). Targeting this substrate by ablation in addition to pulmonary vein ablation did not consistently improve outcome in clinical trials. Generally, the assessment of the substrate is based on short recordings (≤10 s, often even shorter). Thus, targeting the AF substrate assumes spatiotemporal stationarity but little is known about the variability of electrophysiological properties of AF over time.Methods: Atrial fibrillation (AF) was maintained for 3–4 weeks after pericardial electrode implantation in 12 goats. Within a single AF episode 10 consecutive minutes were mapped on the left atrial free wall using a 249-electrode array (2.25 mm inter-electrode spacing). AF cycle length, fractionation index (FI), lateral dissociation, conduction velocity, breakthroughs, and preferentiality of conduction (Pref) were assessed per electrode and AF property maps were constructed. The Pearson correlation coefficient (PCC) between the 10 AF-property maps was calculated to quantify the degree spatiotemporal stationarity of AF properties. Furthermore, the number of waves and presence of re-entrant circuits were analyzed in the first 60-s file. Comparing conduction patterns over time identified recurrent patterns of AF with the use of recurrence plots.Results: The averages of AF property maps were highly stable throughout the ten 60-s-recordings. Spatiotemporal stationarity was high for all 6 property maps, PCC ranged from 0.66 ± 0.11 for Pref to 0.98 ± 0.01 for FI. High stationarity was lost when AF was interrupted for about 1 h. However, the time delay between the recorded files within one episode did not affect PCC. Yet, multiple waves (7.7 ± 2.3) were present simultaneously within the recording area and during 9.2 ± 11% of the analyzed period a re-entrant circuit was observed. Recurrent patterns occurred rarely and were observed in only 3 out of 12 goats.Conclusions: During non-self-terminating AF in the goat, AF properties were stationary. Since this could not be attributed to stable recurrent conduction patterns during AF, it is suggested that AF properties are determined by anatomical and structural properties of the atria even when the conduction patterns are very variable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stationary Atrial Fibrillation Properties in the Goat Do Not Entail Stable or Recurrent Conduction Patterns

et al. 2018

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“…Atrial fibrillation (AF) is the most common arrhythmia diagnosed in clinical practice. It is estimated that AF will affect 6 to 12 million people in the United States by 2050 . Diverse therapeutic strategies have been employed for the conversion of AF to normal sinus rhythm including electrical cardioversion and chronic daily antiarrhythmic medications.…”

Section: Introductionmentioning

confidence: 99%

Multimodal mechanisms and enhanced efficiency of atrial fibrillation cardioversion by pulmonary delivery of a novel flecainide formulation

Silva

Pedreira

Medeiros

et al. 2019

Cardiovasc electrophysiol

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Introduction: Inhaled flecainide significantly alters atrial electrical properties with the potential to terminate atrial fibrillation (AF) efficiently by optimizing dose and drug formulation. Methods: Seventeen Yorkshire pigs were studied. Intrapericardial acetylcholine and burst pacing were used to induce AF. Effects of a novel cyclodextrin formulation (hydroxypropyl-ß-cyclodextrin [HPßCD]) of flecainide (75 mg/mL, 0.5 or 1.0 mg/kg, bolus) instilled intratracheally at 2 minutes after AF initiation were studied. Concentration time-area analyses of flecainide HPßCD were compared to the traditional acetate formulation.Results: Intratracheal instillation of flecainide HPßCD accelerated the conversion of AF to sinus rhythm in a dose-proportional manner, shortening AF duration by 47% (P = .014) and 79% (P = .002) at the lower and higher doses, respectively, compared to intratracheal sterile water placebo. AF dominant frequency was reduced by 11% (P = .04) and 29% (P = .004) respective to dose. At 2 minutes after intratracheal flecainide HPßCD, atrial depolarization (P a ) duration increased by 12% (P = .02) and 17% (P = .009) at the lower and higher doses, respectively. At this time, the PR interval was prolonged by 9% (P = .04 for the higher dose) and AV node conduction was slowed, decreasing the ventricular rate during AF by 16% (P = .002) and 28% (P = .007) for the lower and higher doses. Flecainide HPßCD achieved the more efficient conversion of AF than the acetate formulation, reflected in a markedly reduced area under the curve (P = .04). Conclusion: Intratracheal instillation of the new flecainide HPßCD formulation effectively terminates AF through efficient multimodal actions including slowing of atrial conduction velocity and decreasing AF dominant frequency, allowing reduced net drug delivery and inhalation time. K E Y W O R D S atrial fibrillation, cyclodextrin, flecainide, pharmacologic conversion, pulmonary delivery

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“…The DF can then be displayed on a 3D map to guide the ablator to sites of high DF thought to be driving the AF (focal source or rotor). The aim of such analysis is to detect sites of high frequency that have been hypothesized to “drive” the fibrillation process (Jalife et al, 2002 ) These sites have been shown by retrospective analysis to identify effective ablation areas (Sanders et al, 2005 ) In an elegant animal study by Kalifa et al, areas of fractionation were demonstrated at the periphery of areas of high dominant frequency (Kalifa et al, 2006 ) The proximity of high DF and CFAE sites has also been demonstrated in high-density mapping of human AF (Stiles et al, 2008 ) Of note, most studies examining DF guided ablation have used off-line analysis, although real-time analysis has also been reported albeit without incremental outcome (Atienza et al, 2014 ) In a systematic review of DF-based approaches, Gadenz et al concluded that DF-based approaches are a useful marker of ablation outcome; however, direct intervention targeting DF sites appears premature with mixed results and too few studies (Gadenz et al, 2017 ) A more recent study using a novel frequency analysis algorithm and longer duration of AF electrograms in search for temporally stable AF drivers has shown some promise (Kimata et al, 2018 ) Ongoing work will help refine our armamentarium toward future targeting of high DF sites to improve outcomes (Sanders et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Targeting the Substrate in Ablation of Persistent Atrial Fibrillation: Recent Lessons and Future Directions

2018

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While isolation of the pulmonary veins is firmly established as effective treatment for the majority of paroxysmal atrial fibrillation (AF) patients, there is recognition that patients with persistent AF have substrate for perpetuation of arrhythmia existing outside of the pulmonary veins. Various computational approaches have been used to identify targets for effective ablation of persistent AF. This paper aims to discuss the clinical aspects of computational approaches that aim to identify critical sites for treatment. Various analyses of electrogram characteristics have been performed with this aim. Leading techniques for electrogram analysis are Complex Fractionated Atrial Electrograms (CFAE) and Dominant Frequency (DF). These techniques have been the subject of clinical trials of which the results are discussed. Evaluation of the activation patterns of atria in AF has been another avenue of research. Focal Impulse and Rotor Modulation (FIRM) mapping and forms of Body Surface Mapping aim to characterize multiple atrial wavelets, macro-reentry and focal sources which have been proposed as basic mechanisms perpetuating AF. Both invasive and non-invasive activation mapping techniques are reviewed. The presence of atrial fibrosis causes non-uniform anisotropic impulse propagation. Therefore, identification of fibrosis by imaging techniques is an avenue of potential research. The leading contender for imaging-based techniques is Cardiac Magnetic Resonance (CMR). As this technology advances, improvements in resolution and scar identification have positioned CMR as the mode of choice for analysis of atrial structure. AF has been demonstrated to be associated with obesity, inactivity and diseases of modern life. An opportunity exists for detailed computational analysis of the impact of risk factor modification on atrial substrate. This ranges from microstructural investigation through to examination at a population level via registries and public health interventions. Computational analysis of atrial substrate has moved from basic science toward clinical application. Future directions and potential limitations of such analyses are examined in this review.

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Clinical Role of Dominant Frequency Measurements in Atrial Fibrillation Ablation – A Systematic Review

Cited by 15 publications

References 31 publications

Stationary Atrial Fibrillation Properties in the Goat Do Not Entail Stable or Recurrent Conduction Patterns

Stationary Atrial Fibrillation Properties in the Goat Do Not Entail Stable or Recurrent Conduction Patterns

Multimodal mechanisms and enhanced efficiency of atrial fibrillation cardioversion by pulmonary delivery of a novel flecainide formulation

Targeting the Substrate in Ablation of Persistent Atrial Fibrillation: Recent Lessons and Future Directions

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