Prolongation of atrial fibrillation cycle length during catheter ablation at sites of maximal dominant frequency

Introduction & Hypothesis: Studies in catheter ablation of atrial fibrillation (AF) show that an increase in cycle length (CL) and higher organization index (OI) is associated with termination of AF. We hypothesize that similar changes can be seen in chemical cardioversion with Flecainide Methods: Patients who were still in AF at the end of catheter ablation for AF were given intravenous flecainide. OI and dominant frequency (DF) were obtained by Fast Fourier Transform of coronary sinus electrograms over 10s in AF, before and after flecainide infusion. Mean CL was also calculated. Results: 28 patients were identified (18 paroxysmal AF and 10 persistent AF). 8 cardioverted to sinus rhythm (SR) with flecainide. In all patients, mean CL increased from 211 ± 44 ms to 321 ± 85 ms (p <0.001). Mean DF decreased from 5.2 ± 1.03 Hz to 3.6 ± 1.04 Hz (p <0.001). Mean OI was 0.33 ± 0.13 before and 0.32 ± 0.11 after flecainide (p = 0.90). Comparing patients who cardioverted to SR with those who did not, OI post-flecainide was 0.41 ± 0.12 vs 0.29 ± 0.10 (p=0.013) and relative change in OI was 29 ± 33% vs −3.9 ± 27% (p=0.016) respectively. No significant difference was noted in the change in CL and DF in the 2 groups. Logistic regression showed that a greater relative increase in OI (p=0.04), a higher OI post-flecainide (p=0.03) and SR at start of procedure (p=0.03) are independently associated with cardioversion to SR with flecainide. Conclusion: Increase in OI, independent of changes to the CL and DF, appears critical to AF termination with flecainide. The increase in OI may reflect an increase in size and reduction in the number of re-entrant circuits, which together with slowing of atrial activation, result in return to SR.

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Letter by Platonov et al Regarding Article, “Dominant Frequency of Atrial Fibrillation Correlates Poorly With Atrial Fibrillation Cycle Length”

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.110.943274 ◽

2010 ◽

Vol 3 (2) ◽

Cited By ~ 3

Author(s):

Pyotr G. Platonov ◽

Martin Stridh ◽

Leif Sörnmo

Keyword(s):

Atrial Fibrillation ◽

Cycle Length ◽

Dominant Frequency

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Clinical Outcomes of Computational Virtual Mapping-Guided Catheter Ablation in Patients With Persistent Atrial Fibrillation: A Multicenter Prospective Randomized Clinical Trial

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.772665 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yong-Soo Baek ◽

Oh-Seok Kwon ◽

Byounghyun Lim ◽

Song-Yi Yang ◽

Je-Wook Park ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Trial ◽

Catheter Ablation ◽

Computational Modeling ◽

Controlled Trial ◽

Dominant Frequency ◽

Complication Rates ◽

Clinical Recurrence ◽

Significant Difference

Background: Clinical recurrence after atrial fibrillation catheter ablation (AFCA) still remains high in patients with persistent AF (PeAF). We investigated whether an extra-pulmonary vein (PV) ablation targeting the dominant frequency (DF) extracted from electroanatomical map–integrated AF computational modeling improves the AFCA rhythm outcome in patients with PeAF.Methods: In this open-label, randomized, multi-center, controlled trial, 170 patients with PeAF were randomized at a 1:1 ratio to the computational modeling-guided virtual DF (V-DF) ablation and empirical PV isolation (E-PVI) groups. We generated a virtual dominant frequency (DF) map based on the atrial substrate map obtained during the clinical AF ablation procedure using computational modeling. This simulation was possible within the time of the PVI procedure. V-DF group underwent extra-PV V-DF ablation in addition to PVI, but DF information was not notified to the operators from the core lab in the E-PVI group.Results: After a mean follow-up period of 16.3 ± 5.3 months, the clinical recurrence rate was significantly lower in the V-DF than with E-PVI group (P = 0.018, log-rank). Recurrences appearing as atrial tachycardias (P = 0.145) and the cardioversion rates (P = 0.362) did not significantly differ between the groups. At the final follow-up, sinus rhythm was maintained without any AADs in 74.7% in the V-DF group and 48.2% in the E-PVI group (P < 0.001). No significant difference was found in the major complication rates (P = 0.489) or total procedure time (P = 0.513) between the groups. The V-DF ablation was independently associated with a reduced AF recurrence after AFCA [hazard ratio: 0.51 (95% confidence interval: 0.30–0.88); P = 0.016].Conclusions: The computational modeling-guided V-DF ablation improved the rhythm outcome of AFCA in patients with PeAF.Clinical Trial Registration: Clinical Research Information Service, CRIS identifier: KCT0003613.

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Kolmogorov Complexity of Coronary Sinus Atrial Electrograms before Ablation Predicts Termination of Atrial Fibrillation after Pulmonary Vein Isolation

Entropy ◽

10.3390/e21100970 ◽

2019 ◽

Vol 21 (10) ◽

pp. 970 ◽

Cited By ~ 1

Author(s):

Stępień ◽

Kuklik ◽

Żebrowski ◽

Sanders ◽

Derejko ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Coronary Sinus ◽

Kolmogorov Complexity ◽

Similarity Index ◽

Dominant Frequency ◽

Significant Difference ◽

The Rich

Atrial fibrillation (AF) is related to a very complex local electrical activity reflected in the rich morphology of intracardiac electrograms. The link between electrogram complexity and efficacy of the catheter ablation is unclear. We test the hypothesis that the Kolmogorov complexity of a single atrial bipolar electrogram recorded during AF within the coronary sinus (CS) at the beginning of the catheter ablation may predict AF termination directly after pulmonary vein isolation (PVI). The study population consisted of 26 patients for whom 30 s baseline electrograms were recorded. In all cases PVI was performed. If AF persisted after PVI, ablation was extended beyond PVs. Kolmogorov complexity estimated by Lempel–Ziv complexity and the block decomposition method was calculated and compared with other measures: Shannon entropy, AF cycle length, dominant frequency, regularity, organization index, electrogram fractionation, sample entropy and wave morphology similarity index. A 5 s window length was chosen as optimal in calculations. There was a significant difference in Kolmogorov complexity between patients with AF termination directly after PVI compared to patients undergoing additional ablation (p < 0.01). No such difference was seen for remaining complexity parameters. Kolmogorov complexity of CS electrograms measured at baseline before PVI can predict self-termination of AF directly after PVI.

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The Relationship Between Electrogram Cycle Length and Dominant Frequency in Patients with Persistent Atrial Fibrillation

Journal of Cardiovascular Electrophysiology ◽

10.1111/j.1540-8167.2009.01580.x ◽

2009 ◽

Vol 20 (12) ◽

pp. 1336-1342 ◽

Cited By ~ 18

Author(s):

SHELDON M. SINGH ◽

E. KEVIN HEIST ◽

JACOB S. KORUTH ◽

CONOR D. BARRETT ◽

JEREMY N. RUSKIN ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cycle Length ◽

Persistent Atrial Fibrillation ◽

Dominant Frequency ◽

The Relationship

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

Computer Methods and Programs in Biomedicine ◽

10.1016/j.cmpb.2017.01.011 ◽

2017 ◽

Vol 141 ◽

pp. 83-92 ◽

Cited By ~ 10

Author(s):

Xin Li ◽

João L Salinet ◽

Tiago P Almeida ◽

Frederique J Vanheusden ◽

Gavin S Chu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Persistent Atrial Fibrillation ◽

Dominant Frequency ◽

Guide Catheter ◽

Phase Mapping

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A critical decrease in dominant frequency and clinical outcome after catheter ablation of persistent atrial fibrillation

Heart Rhythm ◽

10.1016/j.hrthm.2009.11.024 ◽

2010 ◽

Vol 7 (3) ◽

pp. 295-302 ◽

Cited By ~ 50

Author(s):

Kentaro Yoshida ◽

Aman Chugh ◽

Eric Good ◽

Thomas Crawford ◽

James Myles ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Clinical Outcome ◽

Persistent Atrial Fibrillation ◽

Dominant Frequency

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Characterization of Electrograms from Multipolar Diagnostic Catheters during Atrial Fibrillation

BioMed Research International ◽

10.1155/2015/272954 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 7

Author(s):

Prasanth Ganesan ◽

Elizabeth M. Cherry ◽

Arkady M. Pertsov ◽

Behnaz Ghoraani

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Simulation Study ◽

Cycle Length ◽

Human Subject ◽

Conduction Delay ◽

Ablation Procedure ◽

Endocardial Surface ◽

Diagnostic Catheter

Atrial fibrillation (AF) is the most common arrhythmia in USA with more than 2.3 million people affected annually. Catheter ablation procedure is a method for treatment of AF, which involves 3D electroanatomic mapping of the patient's left atrium (LA) by maneuvering a conventional multipolar diagnostic catheter (MPDC) along the LA endocardial surface after which pulmonary vein (PV) isolation is performed, thus eliminating the AF triggers originating from the PVs. However, it remains unclear how to effectively utilize the information provided by the MPDC to locate the AF-sustaining sites, known as sustained rotor-like activities (RotAs). In this study, we use computer modeling to investigate the variations in the characteristics of the MPDC electrograms, namely, total conduction delay (TCD) and average cycle length (CL), as the MPDC moves towards a RotA source. Subsequently, a study with a human subject was performed in order to verify the predictions of the simulation study. The conclusions from this study may be used to iteratively direct an MPDC towards RotA sources thus allowing the RotAs to be localized for customized and improved AF ablation.

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Panoramic Endocardial Optical Mapping Demonstrates Serial Rotors Acceleration and Increasing Complexity of Activity During Onset of Cholinergic Atrial Fibrillation

Journal of the American Heart Association ◽

10.1161/jaha.121.022300 ◽

2021 ◽

Author(s):

Óscar Salvador‐Montañés ◽

Rafael J. Ramirez ◽

Yoshio Takemoto ◽

Steven R. Ennis ◽

Daniel Garcia‐Iglesias ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cycle Length ◽

Optical Mapping ◽

Dominant Frequency ◽

Right Atrial ◽

Mapping System ◽

Left And Right ◽

Initiation Stage ◽

Mean Cycle ◽

Onset Atrial Fibrillation

Background Activation during onset of atrial fibrillation is poorly understood. We aimed at developing a panoramic optical mapping system for the atria and test the hypothesis that sequential rotors underlie acceleration of atrial fibrillation during onset. Methods and Results Five sheep hearts were Langendorff perfused in the presence of 0.25 µmol/L carbachol. Novel optical system recorded activations simultaneously from the entire left and right atrial endocardial surfaces. Twenty sustained (>40 s) atrial fibrillation episodes were induced by a train and premature stimuli protocol. Movies obtained immediately (Initiation stage) and 30 s (Early Stabilization stage) after premature stimulus were analyzed. Serial rotor formation was observed in all sustained inductions and none in nonsustained inductions. In sustained episodes maximal dominant frequency increased from (mean±SD) 11.5±1.74 Hz during Initiation to 14.79±1.30 Hz at Early Stabilization ( P <0.0001) and stabilized thereafter. At rotor sites, mean cycle length (CL) during 10 prerotor activations increased every cycle by 0.53% ( P =0.0303) during Initiation and 0.34% ( P =0.0003) during Early Stabilization. In contrast, CLs at rotor sites showed abrupt decreases after the rotors appearances by a mean of 9.65% ( P <0.0001) during both stages. At Initiation, atria‐wide accelerations and decelerations during rotors showed a net acceleration result whereby post‐rotors atria‐wide minimal CL (CLmin) were 95.5±6.8% of the prerotor CLmin ( P =0.0042). In contrast, during Early Stabilization, there was no net acceleration in CLmin during accelerating rotors (prerotor=84.9±11.0% versus postrotor=85.8±10.8% of Initiation, P =0.4029). Levels of rotor drift distance and velocity correlated with atria‐wide acceleration. Nonrotor phase singularity points did not accelerate atria‐wide activation but multiplied during Initiation until Early Stabilization. Increasing number of singularity points, indicating increased complexity, correlated with atria‐wide CLmin reduction ( P <0.0001). Conclusions Novel panoramic optical mapping of the atria demonstrates shortening CL at rotor sites during cholinergic atrial fibrillation onset. Atrial fibrillation acceleration toward Early Stabilization correlates with the net result of atria‐wide accelerations during drifting rotors activity.

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