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

Brown, Jason P.; Krummen, David E.; Feld, Gregory K.; Narayan, Sanjiv M.

doi:10.1016/j.jacc.2006.10.080

Cited by 37 publications

(33 citation statements)

References 20 publications

(31 reference statements)

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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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“…We measured AFCL from the proximal coronary sinus, using our sliding correlation approach to eliminate ventricular artifact, followed by autocorrelation analyses of AF CL as we 24, 25 and others 26 have described.…”

Section: Methodsmentioning

confidence: 99%

Early temporal and spatial regularization of persistent atrial fibrillation predicts termination and arrhythmia-free outcome

et al. 2011

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Background Termination of persistent atrial fibrillation (AF) is a valuable ablation endpoint, but is difficult to anticipate. We evaluated whether temporal and spatial indices of AF regularization predict intra-procedural AF termination and outcome. Objective To test whether temporospatial organization of AF after pulmonary vein isolation (PVI) predicts whether subsequent stepwise ablation will terminate persistent AF or predict outcome. Methods In 75 patients with persistent AF, we measured AF cycle length (AFCL), temporal regularity index (TRI, a spectral measure of timing regularity) and spatial regularity index (SRI, cycle-to-cycle variations in spatial vector) between right atrial appendage, proximal and distal coronary sinus before and during stepwise ablation to the endpoint of AF termination. Results AF termination was achieved in 59 patients (79%) by ablation. AF terminated during PVI in 11 patients, who were excluded from analysis. In the remaining 48 patients, TRI and SRI increased during stepwise ablation, as compared to 16 patients without termination (p < 0.05). AFCL prolonged in both groups. From ROC analysis of the first 22 patients (training set), a post-PVI TRI increase predicted AF termination in the latter 42 patients (test set) with PPV 96 %, NPV 53 %, sensitivity 71 % and specificity 91 %. Results were similar for SRI. After 36 months, higher arrhythmia-free outcome was observed in patients in whom PVI caused temporospatial regularization in AF. Conclusions Temporal and spatial regularization of persistent AF after PVI identifies patients in whom stepwise ablation subsequently terminates AF and prevents recurrence.

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“…The method for deriving the correlation time series has been described (7,9). Briefly, we wrote software in Labview (National Instruments, TX) that automatically selects a 120 ms F-wave template.…”

Section: Ecg Analysis: Derivation Of Correlation Time Seriesmentioning

confidence: 99%

“…Moreover, in the absence of typical F-waves, AFL localization is imprecise (4,5), and many atypical AFL circuits can mimic 'typical' F-waves (4). Even features such as F-wave polarity may be misleading since, for example, positive F-waves in V1 occur both in typical AFL in the right atrium (RA) (1) and with atypical AFL in the LA (6,7). For left-sided atypical AFL, F-waves may have lower amplitude (5), but this has not been tested as a means of localizing the circuit from the ECG.…”

Section: Introductionmentioning

confidence: 99%

Localizing circuits of atrial macroreentry using electrocardiographic planes of coherent atrial activation

et al. 2007

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

Abstract: Quantitative ECG indexes of shorter atrial activation and longer diastolic interval separate focal from macro-re-entrant AT without diagnostic maneuvers.

Cited by 37 publications

References 20 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

Early temporal and spatial regularization of persistent atrial fibrillation predicts termination and arrhythmia-free outcome

Localizing circuits of atrial macroreentry using electrocardiographic planes of coherent atrial activation

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