Separating Atrial Flutter From Atrial Fibrillation With Apparent Electrocardiographic Organization Using Dominant and Narrow F-Wave Spectra

Hoppe, Bobbi; Kahn, Andrew; Feld, Gregory K.; Hassankhani, Alborz; Narayan, Sanjiv M.

doi:10.1016/j.jacc.2005.08.048

Cited by 31 publications

(38 citation statements)

References 29 publications

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“…Thus, rather than dichotomizing AF and AT as disorganized or organized, respectively, it may be more accurate to place both rhythms along a continuous spectrum that can be tracked quantitatively. This extends the variability detected in otherwise regular non-cavotricuspid isthmus dependent macro-reentry (9,12,13) or forms of focal AT (14), or the ‘regularization’ in AF sometimes apparent to the naked eye. Results from this study provide spatiotemporal indices that could be used to track effective ablation lesion sets during ongoing AF ablation, to identify times of organization when cardioversion may require less energy, or ultimately for a functional classification of AF that enables therapy to be tailored to individual phenotypes.…”

Section: Discussionsupporting

confidence: 73%

Electrocardiographic spatial loops indicate organization of atrial fibrillation minutes before ablation-related transitions to atrial tachycardia

Baykaner

Trikha

Zaman

et al. 2017

Journal of Electrocardiology

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Background During ablation for atrial fibrillation (AF), it is challenging to anticipate transitions to organized tachycardia (AT). Defining indices of this transition may help to understand fibrillatory conduction and help track therapy. Objective To determine the timescale over which atrial fibrillation (AF) organizes en route to atrial tachycardia (AT) using the ECG referenced to intracardiac electrograms. Methods In 17 AF patients at ablation (58.7±9.6 years; 53% persistent AF) we analyzed spatial loops of atrial activity on the ECG and intracardiac electrograms over successive timepoints. Loops were tracked at precisely 15, 10, 5, 3 and 1 minute prior to defined transitions of AF to AT. Results Organizational indices reliably quantified changes from AF to AT. Spatiotemporal AF organization on the ECG was identifiable at least 15 minutes before AT was established (p=0.02). Conclusions AF shows anticipatory global organization on the ECG minutes before AT is clinically evident. These results offer a foundation to establish when AF therapy is on an effective path, and for a quantitative classification separating AT from AF.

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Section: Discussionsupporting

confidence: 73%

Electrocardiographic spatial loops indicate organization of atrial fibrillation minutes before ablation-related transitions to atrial tachycardia

Baykaner

Trikha

Zaman

et al. 2017

Journal of Electrocardiology

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“…Spectra have been used to estimate CL from the ECG (15,16), yet they were inaccurate in this study, hindered by harmonics and noise (Fig. 2B.III).…”

Section: Discussionmentioning

confidence: 98%

Using Electrocardiographic Activation Time and Diastolic Intervals to Separate Focal From Macro–Re-Entrant Atrial Tachycardias

Brown¹,

Krummen²,

Feld³

et al. 2007

Journal of the American College of Cardiology

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“…AF regularity was quantified by organization index (OI), the ratio of areas under the DF and its first three harmonics (each for a 1-Hz window) to total spectral area from 2.5 Hz up to but not including the fifth harmonic. 18,19 OI near 1 indicates a narrow peak (“organized” AF), and lower OI indicates broad spectral DF (“disorganized” AF). Figures 1 and 2 show narrow spectral DF (high OI).…”

Section: Methodsmentioning

confidence: 99%

Classifying fractionated electrograms in human atrial fibrillation using monophasic action potentials and activation mapping: Evidence for localized drivers, rate acceleration, and nonlocal signal etiologies

et al. 2011

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BACKGROUND Complex fractionated electrograms (CFAEs) detected during substrate mapping for atrial fibrillation (AF) reflect etiologies that are difficult to separate. Without knowledge of local refractoriness and activation sequence, CFAEs may represent rapid localized activity, disorganized wave collisions, or far-field electrograms. OBJECTIVE The purpose of this study was to separate CFAE types in human AF, using monophasic action potentials (MAPs) to map local refractoriness in AF and multipolar catheters to map activation sequence. METHODS MAP and adjacent activation sequences at 124 biatrial sites were studied in 18 patients prior to AF ablation (age 57 ± 13 years, left atrial diameter 45 ± 8 mm). AF cycle length, bipolar voltage, and spectral dominant frequency were measured to characterize types of CFAE. RESULTS CFAE were observed at 91 sites, most of which showed discrete MAPs and (1) pansystolic local activity (8%); (2) CFAE after AF acceleration, often with MAP alternans (8%); or (3) nonlocal (far-field) signals (67%). A fourth CFAE pattern lacked discrete MAPs (17%), consistent with spatial disorganization. CFAE with discrete MAPs and pansystolic activation (consistent with rapid localized AF sites) had shorter cycle length (P <.05) and lower voltage (P <.05) and trended to have higher dominant frequency than other CFAE sites. Many CFAEs, particularly at the septa and coronary sinus, represented far-field signals. CONCLUSION CFAEs in human AF represent distinct functional types that may be separated using MAPs and activation sequence. In a minority of cases, CFAEs indicate localized rapid AF sites. The majority of CFAEs reflect far-field signals, AF acceleration, or disorganization. These results may help to interpret CFAE during AF substrate mapping.

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Separating Atrial Flutter From Atrial Fibrillation With Apparent Electrocardiographic Organization Using Dominant and Narrow F-Wave Spectra

Abstract: In ambiguous ECGs with atypical F waves, spectral evidence for a solitary activation cycle separates AFL from AF with "apparent organization." This approach might improve bedside ECG diagnosis and shed light on intra-atrial organization of both rhythms.

Cited by 31 publications

References 29 publications

Electrocardiographic spatial loops indicate organization of atrial fibrillation minutes before ablation-related transitions to atrial tachycardia

Electrocardiographic spatial loops indicate organization of atrial fibrillation minutes before ablation-related transitions to atrial tachycardia

Using Electrocardiographic Activation Time and Diastolic Intervals to Separate Focal From Macro–Re-Entrant Atrial Tachycardias

Classifying fractionated electrograms in human atrial fibrillation using monophasic action potentials and activation mapping: Evidence for localized drivers, rate acceleration, and nonlocal signal etiologies

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