Recurring patterns of atrial fibrillation in surface ECG predict restoration of sinus rhythm by catheter ablation

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

doi:10.1016/j.compbiomed.2014.09.005

Cited by 16 publications

(15 citation statements)

References 26 publications

(38 reference statements)

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“…While there have been several applications of frequency domain analysis and morphology RQA techniques in the setting of catheter ablation of AF, to the best of our knowledge, there has been no study to date that has shown changes in EGMs as a result of directed rotor ablation (outside of conventional pulmonary vein isolation). Previous studies have suggested the role of DF, OI, and RQA in the prediction of short‐ and long‐term outcomes in AF ablation. Several other studies have also suggested that both OI and morphology RQA may describe foci of atrial organization critical to the maintenance of AF.…”

Section: Discussionsupporting

confidence: 93%

“…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%

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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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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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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“…10 Finally, Di Marco et al have introduced the study of recurrence patterns of AF from the surface ECG to predict CA outcome both in paroxysmal and persistent AF. 15 Although the study was performed with a follow-up of 6 months, they reported that several recurrent plot indices were significant predictors of CA outcome. Thus, the AA entropy of recurrence predicted ablation outcome with an AUC of 0.81 and 0.72 for paroxysmal and persistent AF, respectively.…”

Section: Previous Studiesmentioning

confidence: 98%

“…In contrast, other works have reported that improved prediction outcomes can be achieved by combining the information provided by multi-lead surface ECG recording systems. 15,16,20,39,40 Hence, multi-lead and multi-variable analyses considering the proposed spectral indices as well as other relevant time features have to be considered in the future to improve the CA outcome prediction both for paroxysmal and persistent AF.…”

Section: Limitationsmentioning

confidence: 99%

“…Thus, the AA entropy of recurrence predicted ablation outcome with an AUC of 0.81 and 0.72 for paroxysmal and persistent AF, respectively. 15 Nonetheless, the validation of all the proposed time and frequency features from the ECG, by comparison with internal electrograms, is a pending task for most part of them. Indeed, only some previous studies have tried to validate the surface DF with invasive recordings from different atrial regions, but reporting inconclusive results.…”

Section: Previous Studiesmentioning

confidence: 99%

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Electrocardiographic Spectral Features for Long-Term Outcome Prognosis of Atrial Fibrillation Catheter Ablation

2016

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Atrial fibrillation (AF) is the most common arrhythmia in routine clinical practice. Despite many years of research, its mechanisms still are not well understood, thus reducing the effectiveness of AF treatments. Nowadays, pulmonary vein isolation by catheter ablation is the treatment of choice for AF resistant either to pharmacological or electrical cardioversion. However, given that long-term recurrences are common, an appropriate patient selection before the procedure is of paramount relevance in the improvement of AF catheter ablation outcome. The present work studies how several spectral features of the atrial activity (AA) from a single lead of the surface electrocardiogram (ECG) can become potential pre-ablation predictors of long-term (>2 months) sinus rhythm maintenance. Among all the analyzed spectral features, results indicated that the most significant single predictor of paroxysmal AF ablation treatment outcome was related to the amplitude of the first harmonic of the dominant frequency, providing sensitivity (Se), specificity (Sp) and accuracy (Ac) values of 90%, 42.86 and 77.78%, respectively. On the other hand, the AA harmonic structure was the most significant single predictor for persistent AF, with Se, Sp and Ac values of 100%, 54.55 and 77.27%, respectively. A logistic regression analysis, mainly based on spectral amplitudes as well as on the harmonic structure of the AA, provided a higher predictive ability both for paroxysmal AF (Se = 100%, Sp = 57.14% and Ac = 88.89%) and persistent AF (Se = 90.91%, Sp = 72.73 and Ac = 81.82%). In conclusion, the study of key AA spectral features from the surface ECG can provide a significant preoperative prognosis of AF catheter ablation outcome at long-term follow-up.

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Characterization of f Waves

Sörnmo

Alcaraz

Laguna

et al. 2018

Series in BioEngineering

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Recurring patterns of atrial fibrillation in surface ECG predict restoration of sinus rhythm by catheter ablation

Abstract: Recurring patterns from preprocedural 1-minute recordings of ECG TQ intervals were significant predictors of CA 6-month outcome.

Cited by 16 publications

References 26 publications

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

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

Electrocardiographic Spectral Features for Long-Term Outcome Prognosis of Atrial Fibrillation Catheter Ablation

Characterization of f Waves

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