Identification and annotation of multiple periodic pulse trains using dominant frequency and graph search: Applications in atrial fibrillation rotor detection

Introduction: Spatiotemporal differences in atrial activity are thought to contribute to the maintenance of atrial fibrillation (AF). While recent evidence has identified changes in dominant frequency (DF) during the transition from paroxysmal to persistent AF, little is known about the frequency characteristics of the epicardium during this transition. The purpose of this study was to perform high-resolution mapping of the atrial epicardium and to characterize changes in frequency activity and structural organization during the transition from paroxysmal to persistent AF. Hypothesis: In a porcine model of persistent AF, we tested the hypothesis that the epicardium undergoes spatiotemporal changes in atrial activity and structural organization during persistent AF. Methods: Paroxysmal and persistent AF was induced in adult Yorkshire swine by atrial tachypacing. Atrial morphology was segmented from magnetic resonance imaging and high-resolution patient-specific flexible mapping arrays were 3D printed to match the epicardial contours of the atria. Epicardial activation and DF mapping was performed in four paroxysmal and four persistent AF animals using personalized mapping arrays. Histological analysis was performed to determine structural differences between paroxysmal and persistent AF. Results: The left atrial epicardium was associated with a significant increase in DF between paroxysmal and persistent AF (6.5 ± 0.2 vs. 7.4 ± 0.5 Hz, P = 0.03). High-resolution spatiotemporal mapping identified organized clusters of DF during paroxysmal AF which were lost during persistent AF. The development of persistent AF led to structural remodeling with increased atrial epicardial fibrosis. The organization index (OI) significantly decreased during persistent AF in both the left atria (0.3 ± 0.03 vs. 0.2 ± 0.03, P = 0.01) and right atria (0.33 ± 0.04 vs. 0.23 ± 0.02, P = 0.02). Conclusions: In the porcine model of persistent AF, the epicardium undergoes structural remodeling with increased epicardial fibrosis, reflected by changes in atrial organization index and dominant frequency.

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Systematic differences of non-invasive dominant frequency estimation compared to invasive dominant frequency estimation in atrial fibrillation

Computers in Biology and Medicine ◽

10.1016/j.compbiomed.2018.11.017 ◽

2019 ◽

Vol 104 ◽

pp. 299-309 ◽

Cited By ~ 2

Author(s):

Frederique J. Vanheusden ◽

Gavin S. Chu ◽

Xin Li ◽

João Salinet ◽

Tiago P. Almeida ◽

...

Keyword(s):

Atrial Fibrillation ◽

Frequency Estimation ◽

Dominant Frequency ◽

Non Invasive

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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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Mapping & Ablation19Novel global ultrasound imaging and continuous dipole density mapping: initial findings in AF patients20Low voltage functional myocardium is critical in determining the substrate of post-ablation atrial tachycardia: results from a prospective study using ripple mapping distinguishing low-voltage scar from conducting tissue21Ripple mapping of post infarct ventricular scar to identify conduction channels and guide substrate based ablation22Effect of chamber geometry and activation pattern on optimal local activation time sampling density for tachycardia diagnosis25Clinical measures of good basket placement predict successful outcome from atrial fibrillation rotor ablation26Unipolar electrogram amplitude is reduced at rotor sites critical to focal termination of human persistent AF27Cryoballoon versus point by point radiofrequency ablation or a novel combined approach: long term follow up and comparison of patterns of pulmonary vein reconnection between different ablation strategies in a randomised controlled trial28Recurrent high dominant frequency patterns in persistent atrial fibrillation29Optimisation of late gadolinium enhanced (LGE) cmr imaging of atrial ablation scar30Hyperacute and chronic changes in cerebral magnetic resonance images after PVAC, NMARQ and epicardial thoracoscopic surgical ablation for paroxysmal atrial fibrillation

EP Europace ◽

10.1093/europace/euv326 ◽

2015 ◽

Vol 17 (suppl 5) ◽

pp. v6-v9

Author(s):

P.M. Heck ◽

V. Luther ◽

S.E. Williams ◽

A.A. Schricker ◽

...

Keyword(s):

Atrial Fibrillation ◽

Low Voltage ◽

Dominant Frequency ◽

Magnetic Resonance Images ◽

Successful Outcome ◽

Surgical Ablation ◽

Density Mapping ◽

Atrial Ablation ◽

Randomised Controlled ◽

A Prospective Study

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Abstract 4104: Organization of Atrial Signals is Critical Prior to Cardioversion of Atrial Fibrillation with Intravenous Flecainide: Insight from Spectral Analysis of Intracardiac Electrograms

Circulation ◽

10.1161/circ.118.suppl_18.s_829-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jiun Tuan ◽

Suman Kundu ◽

Mohamed Jeilan ◽

Faizel Osman ◽

Rajkumar Mantravadi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Spectral Analysis ◽

Catheter Ablation ◽

Cycle Length ◽

Dominant Frequency ◽

Relative Increase ◽

Significant Difference ◽

Before And After ◽

Atrial Activation ◽

Relative Change

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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