Spatiotemporal Behavior of High Dominant Frequency During Paroxysmal and Persistent Atrial Fibrillation in the Human Left Atrium

Abstract

Background-Sites of high dominant frequency (DF peak ) are thought to indicate the location of drivers of atrial fibrillation (AF), but characterization of their spatiotemporal distribution and stability, critical to their relevance as targets for catheter ablation, requires simultaneous global mapping of the left atrium. Methods and Results-Noncontact electrograms recorded simultaneously from 256 left atrial sites during spontaneous AF were analyzed. After subtraction of the ventricular component, fast Fourier transform identified the DF at each site. Focal areas of DF peak were defined as those having a DF >20% above all neighboring sites. Twenty-four patients with spontaneous AF (11 paroxysmal and 13 persistent) were studied. In paroxysmal AF, sites of DF peak (mean DF, 11.6±2.9 Hz) were observed in 100% of patients (present during 65% of the mapping period). In contrast, DF peak was detected in only 31% of patients with persistent AF (P<0.001) and for only 5% of the mapping period (P<0.001). In both groups, locations of DF peak varied widely in both consecutive and separated segments of AF (κ coefficient range, -0.07-0.22). Activation sequences around sites of DF peak did not demonstrate centrifugal activation that would be expected from focal drivers. Conclusions-Focal areas of high DF are more frequent in paroxysmal than persistent AF, are spatiotemporally unstable, are not the source of centrifugal activation, and are not, therefore, indicative of fixed drivers of AF. In the absence of spatiotemporal stability, the success of ablation at sites of DF peak cannot be explained by elimination of fixed drivers.(Circ Arrhythm Electrophysiol. 2012;5:650-658.)

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

“…Previous studies showed imperfect correlations between the NCM and contact mapping for 62 random locations in the left atrium [41]. It was also shown that correlation decreased with increasing distance between the endocardial node and the balloon [40,42].…”

Computation and Projection of Spiral Wave Trajectories During Atrial Fibrillation

“…Ablation based on DF has generally not proved effective. [16][17][18] However, not all AF is the same, and a strong correlation between DF and PS location for stationary rotors may exist. 19 …”

The Rotor Revolution

“…The inability to combine low-and high-resolution mapping in the intact human heart may also explain why measures of organization and spatial gradients in AF, such as dominant frequency, organizational index, and Shannon entropy, have proven unstable and of no significant clinical utility. 12,13 That the hierarchical nature of AF organization is only revealed at the most global level using complex algorithms may be considered to obviate the need to understand causation at the cell and tissue level. But this would once again make us slaves to the empirical-like when pulmonary vein encirclement only, with or without the aim of isolation was uniformly applied for all clinical presentations of AF, 14 or when variably defined attractive electrograms 15 were indiscriminately ablated as the empirical adjunct.…”