Real-time dominant frequency mapping and ablation of dominant frequency sites in atrial fibrillation with left-to-right frequency gradients predicts long-term maintenance of sinus rhythm

Abstract

Background-Spectral analysis identifies localized sites of high-frequency activity during atrial fibrillation (AF). We determined the effectiveness of using real-time dominant frequency (DF) mapping for radiofrequency ablation of maximal DF (DFmax) sites and elimination of left-to-right frequency gradients in the long-term maintenance of sinus rhythm (SR) in AF patients.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…Subsequent studies supported the notion that the high DF (DF max ) sites play a role in the maintenance of AF in a significant number of patients. 592,593 …”

“…At a mean of 9.3 ±5.4 months, freedom from AF after one or more ablation procedures was achieved in 88% and 56% of paroxysmal and persistent AF patients, respectively. 593 A more recent prospective randomized clinical trial of 232 patients with paroxysmal comes with a DF-based approach compared with PVI alone. 594 None of the writing group members incorporate DF mapping as a routine AF ablation strategy in initial or repeat ablation of PAF.…”

An interactive platform to guide catheter ablation in human persistent atrial fibrillation using dominant frequency, organization and phase mapping

“…As persAF is a more complex arrhythmia than pAF, the identification of atrial areas for successful ablation in patients with persAF remains a challenge due to the co-existence of multiple arrhythmogenic mechanisms [4,35]. Previous works have shown that the DF measured from AEGs correlates with the local main activation wave during persAF [9, 14,36].…”

“…Recent studies have shown beneficial outcomes in persAF ablation by targeting rotors defined by points of singularity in phase maps [12,13]. Both HDF and phase mapping might help to identify potential AF drivers and ablation of those areas might contribute to AF treatment [13,14].…”

Differences in atrial fibrillation properties under vagal nerve stimulation versus atrial tachycardia remodeling

“…According to studies in isolated sheep heart, most of the high frequency sources exist in the LA and at a critical frequency, a gradient develops between LA and RA. In a recent study, Atienza et al 48 demonstrated that elimination of LA to RA frequency gradients during ablation predicts long-term maintenance of sinus rhythm in AF patients. All these data clearly indicate that high-DF sites play a role in the maintenance of AF in a significant number of patients.…”