A High Baseline Electrographic Organization Level Is Predictive of Successful Termination of Persistent Atrial Fibrillation by Catheter Ablation

Buttu, Andréa; Vesin, Jean‐Marc; Zaen, Jérôme Van; Ballabeni, Pierluigi; Pascale, Patrizio; Forclaz, Andrei; Bisch, Laurence; Rollin, Anne; Roten, Laurent; Pruvot, Étienne

doi:10.1016/j.jacep.2016.05.017

Cited by 6 publications

(5 citation statements)

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“…We show first the application of this algorithm for single-lead ECG signals, and then demonstrate the advantage of using the multi-lead algorithm. We have shown that adaptive, time-variant algorithms outperform methods based on time-invariant band-pass filters (BPF), which could be less accurate for extracting the signal frequency components relevant to AF (Buttu et al, 2016). Here, we used an adaptive frequency tracking scheme to extract: (i) the common oscillatory component present in multi-lead ECG signals, and (ii) the oscillations of the fundamental frequency and its first harmonic from single-lead ECG signals.…”

Section: Calculation Of Ecg Parametersmentioning

confidence: 99%

“…High DF and low OI values, as measured from the surface ECG, have been shown to predict likelihood of arrhythmia recurrence following CA (Szilágyi et al, 2018), and predictive performance has been shown to increase via the inclusion of adaptive frequency tracking organization parameters (Buttu et al, 2016). Based on these studies, here we compared the values of the IF, AOI, SampEn, and FWA at the three procedure steps outlined in section 2.3, for the three patient groups outlined in section 2.1.…”

Section: Patient Group Comparison At Each Ablation Stepmentioning

confidence: 99%

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ECG-Based Indices to Characterize Persistent Atrial Fibrillation Before and During Stepwise Catheter Ablation

et al. 2021

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Background: Consistently successful patient outcomes following catheter ablation (CA) for treatment of persistent atrial fibrillation (pers-AF) remain elusive. We propose an electrocardiogram (ECG) analysis designed to (1) refine selection of patients most likely to benefit from ablation, and (2) examine the temporal evolution of AF organization indices that could act as clinical indicators of ongoing ablation effectiveness and completeness.Method: Twelve-lead ECG was continuously recorded in 40 patients (61 ± 8 years) during stepwise CA (step-CA) procedures for treatment of pers-AF (sustained duration 19 ± 11 months). Following standard pre-processing, ECG signals were divided into 10-s epochs and labeled according to their temporal placement: pre-PVI (baseline), dur-PVI (during pulmonary vein isolation), and post-PVI (during complex-fractionated atrial electrograms and linear ablation). Instantaneous frequency (IF), adaptive organization index (AOI), sample entropy (SampEn) and f-wave amplitude (FWA) measures were calculated and analyzed during each of the three temporal steps. Temporal evolution of these measures was assessed using a statistical test for mean value transitions, as an indicator of changes in AF organization. Results were then compared between: (i) patients grouped according to step-CA outcome; (ii) patients grouped according to type of arrhythmia recurrence following the procedure, if applicable; (iii) within the same patient group during the three different temporal steps.Results: Stepwise CA patient outcomes were as follows: (1) left-atrium (LA) terminated, not recurring (LTN, n = 8), (2) LA terminated, recurring (LTR, n = 20), and (3) not LA terminated, all recurring at follow-up (NLT, n = 12). Among the LTR and NLT patients, recurrence occurred as AF in seven patients and atrial tachycardia or atrial flutter (AT/AFL) in the remaining 25 patients. The ECG measures indicated the lowest level of organization in the NLT group for all ablation steps. The highest organization was observed in the LTN group, while the LTR group displayed an intermediate level of organization. Regarding time evolution of ECG measures in dur-PVI and post-PVI recordings, stepwise ablation led to increases in AF organization in most patients, with no significant differences between the LTN, LTR, and NLT groups. The median decrease in IF and increase in AOI were significantly greater in AT/AFL recurring patients than in AF recurring patients; however, changes in the SampEn and FWA parameters were not significantly different between types of recurrence.Conclusion: Noninvasive ECG measures, though unable to predict arrhythmia recurrence following ablation, show the lowest levels of AF organization in patients that do not respond well to step-CA. Increasing AF organization in post-PVI may be associated with organized arrhythmia recurrence after a single ablation procedure.

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Section: Calculation Of Ecg Parametersmentioning

confidence: 99%

Section: Patient Group Comparison At Each Ablation Stepmentioning

confidence: 99%

ECG-Based Indices to Characterize Persistent Atrial Fibrillation Before and During Stepwise Catheter Ablation

et al. 2021

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“…All patients underwent a step-CA procedure consisting of pulmonary vein isolation (PVI), followed by left atrial (LA) CFAEs ablation and linear ablation (roof and mitral isthmus). The stepwise ablation protocol has been described previously (Buttu et al, 2016;Luca et al, 2020). The details of the ablation procedure are also provided in the Supplementary Material.…”

Section: Patient Population and Ablation Proceduresmentioning

confidence: 99%

“…We recently showed that patients with peAF that are unresponsive to step-CA displayed higher AF complexity at baseline as indicated by higher DF values (Luca et al, 2020) and lower ECG-based organization indices (Buttu et al, 2016;McCann et al, 2021) than patients with successful ablation. Furthermore, we found that a step-CA led to increases in surface ECG AF organization in most patients (McCann et al, 2021), without significant differences between patients who remained in sinus rhythm (SR) in the long term and those who did not.…”

Section: Introductionmentioning

confidence: 99%

Dynamics of Intraprocedural Dominant Frequency Identifies Ablation Outcome in Persistent Atrial Fibrillation

et al. 2021

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Background: The role of dominant frequency (DF) in tracking the efficiency of a stepwise catheter ablation (step-CA) in persistent atrial fibrillation (peAF) remains poorly studied. We hypothesized that the DF time-course during step-CA displays divergent patterns between patients in whom a step-CA successfully restores long-term sinus rhythm (SR) and those with recurrence.Methods: This study involved 40 consecutive patients who underwent a step-CA for peAF (sustained duration 19 ± 11 months). Dominant frequency was computed on electrograms recorded from the right and left atrial appendages (RAA; LAA) and the coronary sinus before and during the step-CA synchronously to the 12-lead ECG. Dominant frequency was defined as the highest peak within the power spectrum.Results: Persistent atrial fibrillation was terminated by a step-CA in 28 patients [left-terminated (LT)], whereas 12 patients remaining in AF after ablation [not left-terminated (NLT)] were cardioverted. Over a mean follow-up of 34 ± 14 months, all NLT patients had a recurrence. Among the 28 LT patients, 20 had a recurrence, while 8 remained in SR throughout follow-up. The RAA and V1 DF had the best predictive values of the procedural failure to terminate AF (area under the curve; AUC 0.84, p < 0.05). A decision tree model including a decrease in LAA DF ≥ 6.61% during the first 20 min following pulmonary vein isolation (PVI) and a baseline RAA DF <5.6 Hz predicted long-term SR restoration with a sensitivity of 83% and a specificity of 93% (p < 0.05).Conclusion: This study found that high baseline DF values are predictive of unfavorable ablation outcomes. The reduction of the LAA DF at early ablation steps following PVI is associated with procedural AF termination and long-term SR maintenance.

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“…AF termination during stepwise ablation of persistent AF has been reported to predict AF recurrence in several studies. [6,21,87–89] The mode of AF termination (directly to sinus rhythm versus via transformation into atrial tachycardia [AT]) was not predictive of recurrence in the majority of studies,but AF termination at index ablation seems associated with a greater proportion of recurrences in the form of AT relative to AF (with a lower total number of arrhythmia recurrences compared to patients without termination). [65,87] This could be explained by differences in the lesion set between patients with termination and without termination, since studies investigating termination used stepwise ablation aimed at AF termination.…”

Section: Functional Endpoints For Af Ablationmentioning

confidence: 99%

Individualised Approaches for Catheter Ablation of AF: Patient Selection and Procedural Endpoints

Johner

Namdar

Shah

2019

Arrhythm Electrophysiol Rev

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Pulmonary vein isolation (PVI) is the cornerstone of AF ablation, but studies have reported improved efficacy with high rates of repeat procedures. Because of the large interindividual variability in the underlying electrical and anatomical substrate, achieving optimal outcomes requires an individualised approach. This includes optimal candidate selection as well as defined ablation strategies with objective procedure endpoints beyond PVI. Candidate selection is traditionally based on coarse and sometimes arbitrary clinical stratification such as AF type, but finer predictors of treatment efficacy including biomarkers, advanced imaging and electrocardiographic parameters have shown promise. Numerous ancillary ablation strategies beyond PVI have been investigated, but the absence of a clear mechanistic and evidence-based endpoint, unlike in other arrhythmias, has remained a universal limitation. Potential endpoints include functional ones such as AF termination or non-inducibility and substrate-based endpoints such as isolation of low-voltage areas. This review summarises the relevant literature and proposes guidance for clinical practice and future research.

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A High Baseline Electrographic Organization Level Is Predictive of Successful Termination of Persistent Atrial Fibrillation by Catheter Ablation

Abstract: Patients in whom pAF terminated within the LA exhibited a higher level of atrial ECG organization, which was suggestive of a limited number of LA drivers than that of patients in whom the pAF could not be terminated by CA.

Cited by 6 publications

References 22 publications

ECG-Based Indices to Characterize Persistent Atrial Fibrillation Before and During Stepwise Catheter Ablation

ECG-Based Indices to Characterize Persistent Atrial Fibrillation Before and During Stepwise Catheter Ablation

Dynamics of Intraprocedural Dominant Frequency Identifies Ablation Outcome in Persistent Atrial Fibrillation

Individualised Approaches for Catheter Ablation of AF: Patient Selection and Procedural Endpoints

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