A noninvasive method for the detection of dual atrioventricular node physiology in chronic atrial fibrillation

Characterization and Modeling of Atrioventricular Conduction during Atrial Fibrillation

“…Several considerations should be done about the interpretations of the clusters on the Poincaré plot. Different authors have suggested that the presence of bimodal RR histograms or clusters in the Poincaré plot indicates a dual AV nodal physiology [40,60,41]. However, the study of RR interval series with the Poincaré analysis does not provide direct evidence of the dual pathways [60,41].…”

“…By using the bimodal distribution existence as guidance, several studies have reported the effects of SP pathway ablation [41,42,43]. Despite the attractiveness of this phenomenon, the bimodal RR interval distribution analysis does not provide full accuracy, and unimodal histogram pattern may still be associated with dual AV node pathways [41].…”

“…Despite the attractiveness of this phenomenon, the bimodal RR interval distribution analysis does not provide full accuracy, and unimodal histogram pattern may still be associated with dual AV node pathways [41]. Therefore, while AV node modification should be expected in general to alter the distribution of the ventricular RR intervals, it remains difficult to associate particular points in the histogram distribution with beats propagated via the FP or SP during AF.…”

“…Different authors have suggested that the presence of bimodal RR histograms or clusters in the Poincaré plot indicates a dual AV nodal physiology [40,60,41]. However, the study of RR interval series with the Poincaré analysis does not provide direct evidence of the dual pathways [60,41]. It is unclear whether the two pathway properties can be evaluated from the two distributions of the Poincaré plot and the role of the second pathway in the conduction curve needs to be clarified [3,47,44,45,46].…”

“…However, the VR during AF presents additional particular characteristics that can be analyzed by different signal processing techniques [53,49]. By constructing histograms of RR intervals during AF, different populations of more probable RR intervals can be found [95,40,41]. Additionally, different clusters of RR interval sequences can be made visible in Poincaré plots combined with histographic information [60,52,96].…”