Increase in organization index predicts atrial fibrillation termination with flecainide post-ablation: spectral analysis of intracardiac electrograms

Tuan, Jiun; Osman, Faizel; Jeilan, Mohamed; Kundu, Suman; Mantravadi, Rajkumar; Pj, Stafford; Ng, Guseva

doi:10.1093/europace/eup405

Cited by 22 publications

(28 citation statements)

References 23 publications

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“…During the same time phase, an 8-s segment of the bipolar signals recorded from these CFAEs sites were stored on the LabSystem Pro. The bipolar signals were highpass filtered at 1 Hz, rectified, and then low-pass filtered with a 20-Hz cutoff according to the methods of Lazar et al [10][11][12][13]. The Fourier transform (FFT) was retrospectively analyzed with a spectral resolution of 0.24 Hz for each 8-s segment of the bipolar signals with a 50% overlap to obtain the power spectrum.…”

Section: Cfaes and Fast Fourier Transform Analysesmentioning

confidence: 99%

Effects of inter-electrode spacing on complex fractionated atrial electrograms and dominant frequency detection

Nagashima

Okumura

Watanabe

et al. 2012

J Interv Card Electrophysiol

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Section: Cfaes and Fast Fourier Transform Analysesmentioning

confidence: 99%

Effects of inter-electrode spacing on complex fractionated atrial electrograms and dominant frequency detection

Nagashima

Okumura

Watanabe

et al. 2012

J Interv Card Electrophysiol

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“…Flecainide may slow the atrial activation rate and eventually terminate AF by decreasing excitability, increasing the size and decreasing the number of re‐entrant circuits,18 primarily by widening the temporal excitable gap (the difference between AF cycle length [AFCL] and aERP during AF),16, 17 by changing the appearance of the rotating wavefront or some combination of these effects 21, 22, 23. In animal tachypacing models and in human AF patients, flecainide caused increased AFCL, decreased conduction velocity and caused a minor tachycardia‐dependent increase in aERP 17, 24, 25, 26, 27, 28, 29. In horses, a marked flecainide‐induced increase in AFCL has been reported,2 but the effects of flecainide on aERP, AF duration, and AF vulnerability have not yet been investigated.…”

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confidence: 99%

Antiarrhythmic and Electrophysiologic Effects of Flecainide on Acutely Induced Atrial Fibrillation in Healthy Horses

Haugaard

Pehrson

Carstensen

et al. 2014

Veterinary Internal Medicne

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BackgroundOnly few pharmacologic compounds have been validated for treatment of atrial fibrillation (AF) in horses. Studies investigating the utility and safety of flecainide to treat AF in horses have produced conflicting results, and the antiarrhythmic mechanisms of flecainide are not fully understood.ObjectivesTo study the potential of flecainide to terminate acutely induced AF of short duration (≥15 minutes), to examine flecainide‐induced changes in AF duration and AF vulnerability, and to investigate the in vivo effects of flecainide on right atrial effective refractory period, AF cycle length, and ventricular depolarization and repolarization.AnimalsNine Standardbred horses. Eight received flecainide, 3 were used as time‐matched controls, 2 of which also received flecainide.MethodsProspective study. The antiarrhythmic and electrophysiologic effects of flecainide were based on 5 parameters: ability to terminate acute pacing‐induced AF (≥15 minutes), and drug‐induced changes in atrial effective refractory period, AF duration, AF vulnerability, and ventricular depolarization and repolarization times. Parameters were assessed at baseline and after flecainide by programmed electrical stimulation methods.ResultsFlecainide terminated all acutely induced AF episodes (n = 7); (AF duration, 21 ± 5 minutes) and significantly decreased the AF duration, but neither altered atrial effective refractory period nor AF vulnerability significantly. Ventricular repolarization time was prolonged between 8 and 20 minutes after initiation of flecainide infusion, but no ventricular arrhythmias were detected.Conclusions and Clinical ImportanceFlecainide had clear antiarrhythmic properties in terminating acute pacing‐induced AF, but showed no protective properties against immediate reinduction of AF. Flecainide caused temporary prolongation in the ventricular repolarization, which may be a proarrhythmic effect.

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“…30, 31 Singh et al 30 reported the intraprocedural use of ibutilide to organize atrial activity and facilitate AF termination in a modified stepwise approach to persistent AF ablation. This approach may help identify important areas maintaining AF and minimize the ablation lesion set.…”

Section: Variation In Current Ablation Approaches To Persistent Af Anmentioning

confidence: 99%

Is Ablation to Termination the Best Strategy for Ablation of Persistent Atrial Fibrillation?

Lim

Derval

Komatsu³

et al. 2015

Circ: Arrhythmia and Electrophysiology

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A lthough effective results are attained with paroxysmal atrial fibrillation (AF) ablation based on pulmonary vein isolation (PVI), catheter ablation of persistent AF remains a challenging task. Current ablation approaches in persistent AF ablation are markedly diverse, and there is a considerable variation in the reported clinical outcomes.1 Moreover, the lack of a distinct procedural end point makes comparison between the studies difficult. Response by Latchamsetty and Oral on p 971Recently, significant advances have been made with the development of novel technologies, such as computational mapping and panoramic noninvasive mapping to map drivers (rotors and focal discharges) during AF. The advent of these newer technologies and strategies for persistent AF ablation further raise the question as to whether AF termination should be the procedural end point, and whether it confers additional long-term clinical benefit.In this article, we review the current evidence on AF termination and long-term clinical outcome, procedural AF termination as a predictor of freedom from recurrent atrial arrhythmias, AF termination rates with various ablation strategies, and potential underlying mechanisms conferring clinical benefit and future directions. AF Termination and Clinical Outcome Search StrategyThe English scientific literature in the PubMed database was searched using the terms catheter ablation, persistent AF, and termination in any region of the PubMed record until October 2014. Studies that described procedural AF termination rates during ablation together with clinical outcomes after ablation for patients with persistent AF or long-standing persistent AF were included. References from the relevant articles were reviewed to identify further related articles. Definition of AF termination included direct conversion to sinus rhythm (SR) and organization to atrial tachycardia (AT) during ablation.

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Increase in organization index predicts atrial fibrillation termination with flecainide post-ablation: spectral analysis of intracardiac electrograms

Abstract: Increase in OI, independent of changes to CL and DF, appears critical to AF termination with flecainide. Increase in OI holds promise as a sensitive predictor of AF termination.

Cited by 22 publications

References 23 publications

Effects of inter-electrode spacing on complex fractionated atrial electrograms and dominant frequency detection

Effects of inter-electrode spacing on complex fractionated atrial electrograms and dominant frequency detection

Antiarrhythmic and Electrophysiologic Effects of Flecainide on Acutely Induced Atrial Fibrillation in Healthy Horses

Is Ablation to Termination the Best Strategy for Ablation of Persistent Atrial Fibrillation?

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