Different patterns of atrial activation in idiopathic atrial fibrillation: simultaneous multisite atrial mapping in patients with paroxysmal and chronic atrial fibrillation

Gaïta, Fiorenzo; Calò, Leonardo; Riccardi, Riccardo; Garberoglio, Lucia; Scaglione, Mariano; Licciardello, Giovanni; Coda, Luisella; Donna, Paolo Di; Bocchiardo, Mario; Caponi, Domenico; Antolini, R.; Orzan, F; Trevi, G. P.

doi:10.1016/s0735-1097(00)01120-7

Cited by 56 publications

(52 citation statements)

References 28 publications

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“…The output index of the manual analysis (HI) was obtained by dividing the number of type i activations by the number of activations found in the recording. According to previous studies (GAITA et al, 1998;2001) a recording was considered to be organised when a prevalence of type i activations (HI > 0.5) was revealed.…”

Section: Manual Analysismentioning

confidence: 99%

Principal component analysis and cluster analysis for measuring the local organisation of human atrial fibrillation

Faes

Nollo

Kirchner³

et al. 2001

Med. Biol. Eng. Comput.

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The distribution of atrial electrogram types has been proposed to characterise human atrial fibrillation. The aim of this study was to provide computer procedures for evaluating the local organisation of intracardiac recordings during AF as an alternative to off-line manual classification. Principal component analysis (PCA) reduced the data set to a few representative activations, and cluster analysis (CA) measured the average dissimilarity between consecutive activations of an intracardiac signal. The data set consisted of 106 bipolar signals recorded on 11 patients during electrophysiological studies for catheter ablation. Performances of PCA and CA in distinguishing between organised (type I) and disorganised (type II/III, Wells criteria) were assessed, in comparison with manual reading, by evaluating the predictive parameters of the classification analysis. Both methods gave high accuracy (92% for PCA and 89% for CA), confirming the feasibility of on-line characterisation of AF. Sensitivity was lower than specificity (81% against 98% for PCA, and 77% against 97% for CA), with seven out of eight misclassifications of PCA in common with CA. Differences between manual and computer analysis may be related to the higher resolution of PCA and CA in the measurement of the organisation of atrial activations. These procedures are suitable for providing automatic (by CA) or semi-automatic (by PCA) measures of the extent of local organisation of AF in the pre-ablation treatment phase.

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Section: Manual Analysismentioning

confidence: 99%

Principal component analysis and cluster analysis for measuring the local organisation of human atrial fibrillation

Faes

Nollo

Kirchner³

et al. 2001

Med. Biol. Eng. Comput.

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“…6,7 These findings suggested the existence of a more complex electrophysiological substrate in patients with persistent AF with structures and mechanisms involved in facilitation and maintenance of the arrhythmia residing outside the pulmonary veins. 8 As a consequence, efforts were redirected toward AF substrate modification with several non-pulmonary veins targets used as guidance for transcatheter ablation. Linear ablation between fixed anatomic structures (eg, left atrial roof and mitral isthmus) provided additional benefit to circumferential pulmonary vein isolation in patients with persistent AF.…”

Section: See Article By Yang Et Almentioning

confidence: 99%

Electrophysiologically Guided Substrate Modification During Sinus Rhythm

Gaïta

Castagno

2016

Circ: Arrhythmia and Electrophysiology

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A trial fibrillation, the most common sustained cardiac arrhythmia, has a complex and multifaceted pathophysiology. 1 The presence of a predisposing substrate, frequently encompassing atrial hypertrophy, fibrosis, and significant alterations of the extracellular matrix, is contributing to intra-atrial electric conduction delay as well as shortening and dispersion of atrial refractory periods. Triggers such as short-coupled supraventricular extrasystoles can initiate the arrhythmia acting on this pathological milieu with the potential contribution of modulating factors, such as the autonomic nervous system, ischemia, and hormones. See Article by Yang et alThe initial clinical experiences of transcatheter ablation of atrial fibrillation (AF) were reported 20 years ago almost simultaneously by different groups.2,3 Mimicking atrial debulking and compartmentalization provided by surgical techniques such as the classical Maze procedure, these transcatheter approaches aimed at substantial atrial substrate modification. A few years later, the recognition by Haïssaguerre et al 4 that most of the ectopic foci initiating AF were located in the pulmonary veins, shifted the attention of the electrophysiological community from substrate to triggers of the arrhythmia. The observation that ablation with local radiofrequency energy of the ectopic foci achieved 62% freedom from AF, paved the way for circumferential pulmonary vein isolation widespread use, which soon became the cornerstone of paroxysmal AF interventional treatment showing higher efficacy when compared with antiarrhythmic drugs. 5 However, in patients presenting with persistent AF, pulmonary vein isolation proved to be insufficient if used as stand-alone ablation strategy showing only modest long-term success rates. 6,7 These findings suggested the existence of a more complex electrophysiological substrate in patients with persistent AF with structures and mechanisms involved in facilitation and maintenance of the arrhythmia residing outside the pulmonary veins.8 As a consequence, efforts were redirected toward AF substrate modification with several non-pulmonary veins targets used as guidance for transcatheter ablation. Linear ablation between fixed anatomic structures (eg, left atrial roof and mitral isthmus) provided additional benefit to circumferential pulmonary vein isolation in patients with persistent AF. 9,10Subsequently, mapping and ablation of complex-fractionated atrial electrograms defined as either continuous reentry of the fibrillation waves into the same area or overlap of different wavelets entering the same area at different times, was proposed by Nademanee et al 11 as a new ablative approach aiming at AF substrate modification. Other groups studied the role of autonomic nervous system in AF pathophysiology investigating the curative effects of partial vagal denervation secondary to atrial ganglia transcatheter ablation. 12,13 In clinical practice, different combinations of these ablative approaches have been tested for the treatment of persistent...

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“…An analysis looking at these characteristics in AF EGMs has a peculiar electrophysiological relevance, as it may reflect the propagation patterns underlying the maintenance of AF [6]. Indeed, the Wells' approach has been used in several clinical and experimental studies to identify organization patterns in paroxysmal and chronic AF and to support the ablative treatment of AF [39]. In addition, many authors have proposed to quantify automatically single-lead EGMs organization by using analysis of fractal fluctuations and entropy measures.…”

Section: Intraatrial Organization Assessmentmentioning

confidence: 99%

The Contribution of Nonlinear Methods in the Understanding of Atrial Fibrillation

Alcaraz¹,

Rieta²

2013

Atrial Fibrillation - Mechanisms and Treatment

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Additionally, the f wave analysis from surface ECG recordings is complicated by the simultaneous presence of VA, which is of much higher amplitude. Thereby, the dissociation of atrial and ventricular components is mandatory [12]. Nowadays, several methods to extract the AA signal from surface ECG recordings exist. The most powerful techniques are those that exploit the spatial diversity of the multilead ECG, such as the method that solves the blind source separation problem [3] or the spatiotemporal QRST cancellation strategy [13]. However, the performance of these techniques is seriously reduced when recordings are obtained from Holter systems for paroxysmal AF analysis. The reason is that, generally, Holter systems use no more than two or three leads, which are not enough to exploit the ECG spatial information. For single-lead applications, the most widely used alternative to extract the AA is the averaged beat subtraction (ABS). This method relies on the assumption that the average beat can represent, approximately, each individual beat [12]. Recently, a variety of extensions for this method have been proposed [12,14]. Intraatrial EGMNowadays, a variety of intraatrial recording modalities exists, such as bipolar and unipolar recordings from endocardial and epicardial electrodes, optical mapping and noncontact Atrial Fibrillation -Mechanisms and Treatment 182 mapping [15]. Although recordings from each one of these modalities have their own characteristics, unipolar recordings are generally characterized by a substantial far-field contamination, such as VA, whereas bipolar recordings contains local atrial activations of the place in which the electrodes are located. Nonetheless, these recordings are also affected by ventricular interference, especially in recording sites closer to the ventricles, even if its effect is less evident than on unipolar EGMs and surface ECG recordings. Thereby, for the VA cancellation both from unipolar and bipolar recordings, an averaged ventricular interference complex, as in ABS, is usually computed and subtracted from each atrial signal [16,17]. Only remark that the ventricular activations are habitually detected from a surface ECG recording simultaneously acquired for more accuracy.On the other hand, given that atrial dynamics can be analyzed both from simple EGMs and local atrial period (LAP) series, i.e., the sequence of temporal distances between two consecutive local atrial activations, the appropriate identification of these points is a important task in this context. For this purpose, EGMs are habitually high-pass filtering (40-250 Hz) to remove baseline shifts and high-frequency noise [18]. The filtered signal is then rectified, introducing low-frequency components related to the amplitude of the high-frequency oscillations of the original signal. The modulus of the filtered signal is further low-pass filtered (cut-off at 20 Hz) to extract a waveform proportional to the amplitude of the components of occurring at 40-250 Hz. The atrial activations are then detected by thr...

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Different patterns of atrial activation in idiopathic atrial fibrillation: simultaneous multisite atrial mapping in patients with paroxysmal and chronic atrial fibrillation

Abstract: Electrical activity during AF showed a significant spatial inhomogeneity, which was more evident in patients with paroxysmal AF. The mean FF intervals did not correlate with the mean ERPs.

Cited by 56 publications

References 28 publications

Principal component analysis and cluster analysis for measuring the local organisation of human atrial fibrillation

Principal component analysis and cluster analysis for measuring the local organisation of human atrial fibrillation

Electrophysiologically Guided Substrate Modification During Sinus Rhythm

The Contribution of Nonlinear Methods in the Understanding of Atrial Fibrillation

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