Dominant Frequency of Atrial Fibrillation Correlates Poorly With Atrial Fibrillation Cycle Length

Elvan, Arif; Linnenbank, André C.; Bemmel, Marnix W. van; Misier, Anand R. Ramdat; Delnoy, Peter Paul H.M.; Beukema, Willem P.; Bakker, Jacques M.T. de

doi:10.1161/circep.108.843284

Cited by 52 publications

(52 citation statements)

References 24 publications

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“…20 Other factors, such as electrogram morphology and amplitude, may also cause the measured DF of bipolar or unipolar electrograms to inaccurately represent underlying tissue activation rates. [20][21][22] On this background, our observation that DF peak is not spatiotemporally stable suggests that the underlying mechanism is not always dependent on a fixed anatomical feature, but rather that DF peak may often be functionally Figure 6). …”

Section: An Alternative Explanation For Df Peakmentioning

confidence: 95%

Spatiotemporal Behavior of High Dominant Frequency During Paroxysmal and Persistent Atrial Fibrillation in the Human Left Atrium

Jarman

Wong

Kojodjojo

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Background-Sites of high dominant frequency (DF peak ) are thought to indicate the location of drivers of atrial fibrillation (AF), but characterization of their spatiotemporal distribution and stability, critical to their relevance as targets for catheter ablation, requires simultaneous global mapping of the left atrium. Methods and Results-Noncontact electrograms recorded simultaneously from 256 left atrial sites during spontaneous AF were analyzed. After subtraction of the ventricular component, fast Fourier transform identified the DF at each site. Focal areas of DF peak were defined as those having a DF >20% above all neighboring sites. Twenty-four patients with spontaneous AF (11 paroxysmal and 13 persistent) were studied. In paroxysmal AF, sites of DF peak (mean DF, 11.6±2.9 Hz) were observed in 100% of patients (present during 65% of the mapping period). In contrast, DF peak was detected in only 31% of patients with persistent AF (P<0.001) and for only 5% of the mapping period (P<0.001). In both groups, locations of DF peak varied widely in both consecutive and separated segments of AF (κ coefficient range, -0.07-0.22). Activation sequences around sites of DF peak did not demonstrate centrifugal activation that would be expected from focal drivers. Conclusions-Focal areas of high DF are more frequent in paroxysmal than persistent AF, are spatiotemporally unstable, are not the source of centrifugal activation, and are not, therefore, indicative of fixed drivers of AF. In the absence of spatiotemporal stability, the success of ablation at sites of DF peak cannot be explained by elimination of fixed drivers.(Circ Arrhythm Electrophysiol. 2012;5:650-658.)

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Section: An Alternative Explanation For Df Peakmentioning

confidence: 95%

Spatiotemporal Behavior of High Dominant Frequency During Paroxysmal and Persistent Atrial Fibrillation in the Human Left Atrium

Jarman

Wong

Kojodjojo

et al. 2012

Circ: Arrhythmia and Electrophysiology

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“…The inability to combine low-and high-resolution mapping in the intact human heart may also explain why measures of organization and spatial gradients in AF, such as dominant frequency, organizational index, and Shannon entropy, have proven unstable and of no significant clinical utility. 12,13 That the hierarchical nature of AF organization is only revealed at the most global level using complex algorithms may be considered to obviate the need to understand causation at the cell and tissue level. But this would once again make us slaves to the empirical-like when pulmonary vein encirclement only, with or without the aim of isolation was uniformly applied for all clinical presentations of AF, 14 or when variably defined attractive electrograms 15 were indiscriminately ablated as the empirical adjunct.…”

Section: Barriers To Progressmentioning

confidence: 99%

The Rotor Revolution

Zaman

Peters

2014

Circ: Arrhythmia and Electrophysiology

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“…1 This figure also shows that accidentally selecting the double frequency is not the only problem. The frequency spectrum is also affected by difference in cycle length, amplitude, and morphology.…”

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confidence: 85%

“…In a response to our article, 1 Platonov et al counter that AF cycle length (AFCL) estimation is too complex and that a method for finding the fundamental or dominant frequency (DF) is to be preferred.…”

mentioning

confidence: 98%

Response to Letter Regarding Article, “Dominant Frequency of Atrial Fibrillation Correlates Poorly With Atrial Fibrillation Cycle Length”

Elvan

Linnenbank

Bakker

2010

Circ: Arrhythmia and Electrophysiology

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Frequency-domain analysis has been considered as an alternative way to visualize atrial fibrillation (AF) electrograms for estimating the rate and regularity of activation without having to measure intervals in the time domain. In a response to our article, 1 Platonov et al counter that AF cycle length (AFCL) estimation is too complex and that a method for finding the fundamental or dominant frequency (DF) is to be preferred.Although we agree that it is not simple to create an algorithm that reliably detects activation under all circumstances, we disagree that this implies that DF computation must be preferred for guiding AF ablation. There are 2 main reasons why AFCL is to be preferred in a clinical application for this.One is that, as shown in Figure 8 of our article, DF is a reliable tool as long as the activations are regular enough. 1 This figure also shows that accidentally selecting the double frequency is not the only problem. The frequency spectrum is also affected by difference in cycle length, amplitude, and morphology.This means that precisely in cases that are clinically interesting, DF is unreliable. There is a famous quote attributed to H.L. Mencken that "for every complex problem, there is a solution that is simple, neat, and wrong." We are sure that he was not referring to DF-guided ablation of AF.Our second reason is that DF analysis is performed on electrograms that are heavily filtered and distorted before applying the Fourier transform. Not many cardiologists are experienced in thinking in frequency domain. Richter et al 2 use a much more complex method that, although it might perform better under certain circumstances, is even less accessible to electrophysiologists. If DF analysis gives a suspicious or even wrong result, it is therefore hard to judge where and why the analysis went wrong. AFCL analysis, on the other hand, can at all times show the signals and the automatically detected activation times. Interpreting electrograms is exactly the expertise of clinical electrophysiologists. Therefore, AFCL is a method that helps the physician to understand the substrate, whereas DF analysis is just a computational tool that computes a number and is often not a reliable measure for AF activation times. DisclosuresNone. Arif Elvan, MD, PhD

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Dominant Frequency of Atrial Fibrillation Correlates Poorly With Atrial Fibrillation Cycle Length

Cited by 52 publications

References 24 publications

Spatiotemporal Behavior of High Dominant Frequency During Paroxysmal and Persistent Atrial Fibrillation in the Human Left Atrium

Spatiotemporal Behavior of High Dominant Frequency During Paroxysmal and Persistent Atrial Fibrillation in the Human Left Atrium

The Rotor Revolution

Response to Letter Regarding Article, “Dominant Frequency of Atrial Fibrillation Correlates Poorly With Atrial Fibrillation Cycle Length”

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