Noninvasive Localization of Maximal Frequency Sites of Atrial Fibrillation by Body Surface Potential Mapping

Abstract

Background Ablation of high-frequency sources in patients with atrial fibrillation (AF) is an effective therapy to restore sinus rhythm. However, this strategy may be ineffective in patients without a significant dominant frequency (DF) gradient. The aim of this study was to investigate whether sites with high-frequency activity in human AF can be identified noninvasively, which should help intervention planning and therapy. Methods and Results In 14 patients with a history of AF, 67-lead body surface recordings were simultaneously registered with 15 endocardial electrograms from both atria including the highest DF site, which was predetermined by atrial-wide real-time frequency electroanatomical mapping. Power spectra of surface leads and the body surface location of the highest DF site were compared with intracardiac information. Highest DFs found on specific sites of the torso showed a significant correlation with DFs found in the nearest atrium (ρ=0.96 for right atrium and ρ=0.92 for left atrium) and the DF gradient between them (ρ=0.93). The spatial distribution of power on the surface showed an inverse relationship between the frequencies versus the power spread area, consistent with localized fast sources as the AF mechanism with fibrillatory conduction elsewhere. Conclusions Spectral analysis of body surface recordings during AF allows a noninvasive characterization of the global distribution of the atrial DFs and the identification of the atrium with the highest frequency, opening the possibility for improved noninvasive personalized diagnosis and treatment.

Noninvasive Identification of Atrial Fibrillation Drivers: Simulation and Patient Data Evaluation

“…Despite this loss of information at the body surface level, surface potentials have shown to keep some relevant attributes of AF drivers both in terms of their activation frequency [12] and rotor location [11]. Here we have shown that activation-based parameters, such as the activation frequency computed by spectral analysis or rotor location computed by applying phase transform, are quite robust against both signal and model uncertainties in our modelling data.…”

“…Power spectral density of all signals was computed using Welch's periodogram (65536 point Fast Fourier transform and 80% overlap) to determine the local DFs with a spectral resolution of 0.01Hz [12]. AF drivers were defined as the center of mass of the region with the highest DF (HDF).…”

Highest Dominant Frequency and Rotor Sites are Robust Markers for Atrial Driver Location in Non:invasive Mapping of Atrial Fibrillation

“…We have recently shown that inverse-computed EGMs are poorly related to contact electrograms (either experimentally measured or simulated), with large relative errors in the instantaneous phase [6]. We have also demonstrated that electrical propagation through the torso is involved in a loss of pattern complexity, which is consistent with a mutual cancellation of propagation wavefronts with opposed directions [6] that may not be retrievable by solving the inverse problem.…”

“…Rotor location was carried out by identification of singularity points (SP) in the phase signal map obtained with the Hilbert Transform [6]. A rotor was defined as the connection between SPs across time and only long lasting rotors, defined as those that complete at least one rotation were considered as rotors and other SPs were discarded.…”

Innovations in Clinical Cardiac Electrophysiology: Challenges and Upcoming Solutions in 2018 and Beyond

“…104 The ablation of high-frequency source areas detected on endocardial mapping was noninferior in comparison with PVI (after multiple procedures) and was associated with lower rates of complications. 105 An observational study is currently underway to validate high-frequency source areas detected by body surface potential mapping using endocardial maps (PERSONALIZE-AF, NCT02497248).…”