Acute effects of complex fractionated atrial electrogram ablation on dominant frequency and regulatory index for the fibrillatory process

Bencsik, Gábor; Martinek, Martin; Hassanein, Said; Aichinger, Josef; Nesser, Hans‐Joachim; Pürerfellner, Helmut

doi:10.1093/europace/eup113

Cited by 9 publications

(15 citation statements)

References 31 publications

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“…During the same time phase, an 8-s segment of the bipolar signals recorded from these CFAEs sites were stored on the LabSystem Pro. The bipolar signals were highpass filtered at 1 Hz, rectified, and then low-pass filtered with a 20-Hz cutoff according to the methods of Lazar et al [10][11][12][13]. The Fourier transform (FFT) was retrospectively analyzed with a spectral resolution of 0.24 Hz for each 8-s segment of the bipolar signals with a 50% overlap to obtain the power spectrum.…”

Section: Cfaes and Fast Fourier Transform Analysesmentioning

confidence: 99%

Effects of inter-electrode spacing on complex fractionated atrial electrograms and dominant frequency detection

Nagashima

Okumura

Watanabe

et al. 2012

J Interv Card Electrophysiol

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Section: Cfaes and Fast Fourier Transform Analysesmentioning

confidence: 99%

Effects of inter-electrode spacing on complex fractionated atrial electrograms and dominant frequency detection

Nagashima

Okumura

Watanabe

et al. 2012

J Interv Card Electrophysiol

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“…Electrogram-guided ablation, in absence of pulmonary vein isolation, also decreases DF [38]. Electrogram-guided ablation following pulmonary vein isolation decreases DF when DF max sites are targeted [31], but not necessarily when CFAE sites are targeted [37], even as subsequent roof and mitral isthmus lines further reduce DF [37]. Often AF converts to an atrial tachycardia, with cycle length corresponding to a minor peak in the baseline AF frequency spectrum, thereby suggesting that a preexisting AF/AT driver has been uncovered by the ablation process [39].…”

Section: Dominant Frequency Mapsmentioning

confidence: 98%

“…Pulmonary vein isolation is associated with a decrease in global DF, leftto-right DF gradient and CFAE burden [35,37,38]. However, the modest correlation between DF and CFAE mean cycle length that exists at baseline breaks down, indicative of the pathophysiologic and algorithmic differences between these parameters [33].…”

Section: Dominant Frequency Mapsmentioning

confidence: 99%

Mapping of Atrial Fibrillation: Comparing Complex Fractionated Atrial Electrograms, Voltage Maps, Dominant Frequency Maps and Ganglionic Plexi

Al‐Ahmad

Schoenhard

2012

Cardiac Mapping

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Catheter-based radio-frequency ablation is an effective therapy for controlling atrial fibrillation (AF) in appropriately selected patients. While anatomic pulmonary vein isolation is typically sufficient for individuals with paroxysmal AF, adjunctive substrate modification within the body of the left atrium is often necessary in individuals with persistant AF. Several cardiac mapping strategies can be used to accurately target ablation for improved efficacy and limit unnecessary ablation for improved safety. These include identification of complex fractionated atrial electrograms, measurement of voltage in sinus rhythm and AF, assessment of dominant frequency and localization of ganglionic plexi. This chapter will compare these overlapping methodologies and provide recommendations with regard to their utilization.

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“…7 -10 Though a large number of studies have provided evidence that fractionated electrograms are indicators of the arrhythmogenic substrate stabilizing atrial fibrillation, it is clear from the inconsistent findings of mapping studies so far that the exact role of fractionation in perpetuation of atrial fibrillation is still not entirely understood. Yet, the findings of Bencsik et al 6 are an important contribution to further refinement of an ablation strategy for atrial fibrillation.…”

Section: Ablative Therapy Targeting Fractionated Extracellular Potentmentioning

confidence: 99%

“…The paper written by Bencsik et al 6 entitled 'the acute effects of complex fractionated electrograms ablation on dominant frequency and regulatory index for fibrillatory process' published in this issue is another elegant study increasing our knowledge of ablative therapy targeting complex fractionated atrial electrograms. In patients with paroxysmal or persistent AF the effects of successively (i) circumferential pulmonary vein isolation, (ii) ablation of fractionated electrograms outside the circular lesions, and (iii) construction of linear lesion across the left atrial roof and mitral isthmus on dominant frequency and regulatory index was studied.…”

Section: Ablative Therapy Targeting Fractionated Extracellular Potentmentioning

confidence: 99%

Fractionated extracellular potentials: indicators of the arrhythmogenic substrate?

Groot

2009

Europace

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This editorial refers to 'Acute effects of complex fractionated atrial electrogram ablation on dominant frequency and regulatory index for the fibrillatory process' by G. Bencsik et al., on page 1011 Mechanisms underlying fractionation of extracellular potentialsFractionated electrograms are defined as extracellular potentials consisting of multiple negative deflections which are the result of local asynchronous activation of atrial tissue beneath the recording electrode.1 Experimental studies have suggested that fractionation of electrograms can be either functional (spatial dispersion of action potential duration) or structural (e.g. tissue anisotropy, collageneous septa) in nature. 2 -4 Spach has demonstrated that the fractionation of extracellular potentials is caused by the deposition of fibrous tissue between muscle fibres. 2,3 The number of side-to-side electrical coupling in the transverse direction is diminished, whereas the electrical coupling in the longitudinal direction remains unaffected. A decrease in side-to-side electrical coupling in the transverse direction leads to an increase in effective axial resistance and hence a local conduction delays in this direction (nonuniform anisotropy). The resulting asynchronous activation of muscle bundles gives rise to fractionation of electrograms. In the goat model of persistent of atrial fibrillation, prolongation of atrial fibrillation cycle length by infusion of a Class I drug was associated with a significant reduction in the incidence of fractionation. 4 Class I drugs prolong atrial fibrillation cycle length more than atrial refractoriness, thereby widening the excitable gap. These findings indicate that the decrease of fractionation was due to widening of the excitable gap as in the presence of a wider excitable gap the wavefront will propagate through muscle which is in a higher state of excitability, suggesting that the fractionation is functionally determined. The importance of fractionated fibrillation potentials as possible indicators of the arrhythmogenic substrate was first suggested by Allessie et al. 5The relation between the morphology of fibrillation electrograms and spatial patterns of activation during atrial fibrillation was studied. For this purpose, fibrillation electrograms recorded from the right atrial free wall in humans were classified as fragmented potentials. Short double potentials were the result of collision of fibrillation waves; long double potentials were recorded along long lines of functional conduction block, whereas fragmented potentials occurred either during pivoting of fibrillatory waves at the end of a line of block or at areas of slow conduction. As abnormalities in conduction resulted in long double and fractionated potentials, it was hypothesized that fibrillation potentials could be used to guide a selective ablation approach.On the basis of this hypothesis, ablative therapy targeting fractionated atrial electrograms have become a topic of interest. Ever since, a series of clinical studies have indeed provided...

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Acute effects of complex fractionated atrial electrogram ablation on dominant frequency and regulatory index for the fibrillatory process

Cited by 9 publications

References 31 publications

Effects of inter-electrode spacing on complex fractionated atrial electrograms and dominant frequency detection

Effects of inter-electrode spacing on complex fractionated atrial electrograms and dominant frequency detection

Mapping of Atrial Fibrillation: Comparing Complex Fractionated Atrial Electrograms, Voltage Maps, Dominant Frequency Maps and Ganglionic Plexi

Fractionated extracellular potentials: indicators of the arrhythmogenic substrate?

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