Severe and uniform bi-atrial remodeling measured by dominant frequency analysis in persistent atrial fibrillation unresponsive to ablation

Luca, Adrian; Pittet, Anthony; Buttu, Andréa; McCann, Anna; Vesin, Jean‐Marc; Pascale, Patrizio; Bloa, Mathieu Le; Herrera, Claudia; Park, Chan-Il; Rollin, Anne; Roten, Laurent; Kühne, Michael; Spies, Florian; Knecht, Sven; Sticherling, Christian; Pruvot, Étienne

doi:10.1007/s10840-019-00681-1

Cited by 3 publications

(5 citation statements)

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“…All patients underwent a step-CA procedure consisting of pulmonary vein isolation (PVI), followed by left atrial (LA) CFAEs ablation and linear ablation (roof and mitral isthmus). The stepwise ablation protocol has been described previously (Buttu et al, 2016;Luca et al, 2020). The details of the ablation procedure are also provided in the Supplementary Material.…”

Section: Patient Population and Ablation Proceduresmentioning

confidence: 99%

“…The following catheters were introduced via the left and right femoral veins: a 3.5-mm cooled-tip catheter for mapping and ablation (Navistar Thermocool, Biosense Webster R , Irwindale, California), a circumferential duodecapolar Lasso R catheter (electrode spacing 2-6-2 mm, Biosense Webster R , Irwindale, California) within the LA, a quadripolar catheter (electrode spacing 5-5-5 mm, 4 mm electrode tip size, Supreme St Jude Medical R , Saint Paul, Minnesota) placed into the right atrial appendage (RAA), and a steerable decapolar catheter (electrode spacing 2-8-2 mm, 1 mm electrode tip size, Biosense Webster R , Irwindale, California) placed into the coronary sinus (CS), with the proximal electrode at the ostium. The ECG chest lead V 6 was placed on the back (V 6b ) of the patients, within the cardiac silhouette, in order to better record LA activity (Luca et al, 2020). Furthermore, EGMs were synchronously recorded from the left atrial appendage (LAA), RAA, and CS at baseline, i.e., before the ablation, during PVI, and throughout CFAEs and the linear ablation.…”

Section: Electrophysiological Studymentioning

confidence: 99%

“…The EGM DFs were computed on the distal dipole of the RAA catheter, on the Lasso R catheter placed within the LAA as the average DF of the 10 dipoles, and on the CS catheter as the average DF of the 5 dipoles. Because the atrial activity is best recognized in the leads V 1 and V 6b (Luca et al, 2020), the ECG DFs were computed only on these two leads. The ECG and EGM signals were divided into 10-s epochs.…”

Section: Data Processingmentioning

confidence: 99%

“…Intracardiac DF is an acceptable surrogate for the degree of atrial remodeling, with high DF values indicative of advanced remodeling (Lemola et al, 2006;Brooks et al, 2010). Our group has recently shown that patients with peAF unresponsive to stepwise ablation had advanced bi-atrial and CS remodeling as shown by high surface and intracardiac DFs (Luca et al, 2020). The clinical role of DF in predicting procedural ablation outcomes has been investigated by several groups.…”

Section: High Baseline Df and Negative Laa-to-raa Df Gradient Are Predictive Of Unfavorable Procedural Ablation Outcomesmentioning

confidence: 99%

“…We recently showed that patients with peAF that are unresponsive to step-CA displayed higher AF complexity at baseline as indicated by higher DF values (Luca et al, 2020) and lower ECG-based organization indices (Buttu et al, 2016;McCann et al, 2021) than patients with successful ablation. Furthermore, we found that a step-CA led to increases in surface ECG AF organization in most patients (McCann et al, 2021), without significant differences between patients who remained in sinus rhythm (SR) in the long term and those who did not.…”

Section: Introductionmentioning

confidence: 99%

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Dynamics of Intraprocedural Dominant Frequency Identifies Ablation Outcome in Persistent Atrial Fibrillation

et al. 2021

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Background: The role of dominant frequency (DF) in tracking the efficiency of a stepwise catheter ablation (step-CA) in persistent atrial fibrillation (peAF) remains poorly studied. We hypothesized that the DF time-course during step-CA displays divergent patterns between patients in whom a step-CA successfully restores long-term sinus rhythm (SR) and those with recurrence.Methods: This study involved 40 consecutive patients who underwent a step-CA for peAF (sustained duration 19 ± 11 months). Dominant frequency was computed on electrograms recorded from the right and left atrial appendages (RAA; LAA) and the coronary sinus before and during the step-CA synchronously to the 12-lead ECG. Dominant frequency was defined as the highest peak within the power spectrum.Results: Persistent atrial fibrillation was terminated by a step-CA in 28 patients [left-terminated (LT)], whereas 12 patients remaining in AF after ablation [not left-terminated (NLT)] were cardioverted. Over a mean follow-up of 34 ± 14 months, all NLT patients had a recurrence. Among the 28 LT patients, 20 had a recurrence, while 8 remained in SR throughout follow-up. The RAA and V1 DF had the best predictive values of the procedural failure to terminate AF (area under the curve; AUC 0.84, p < 0.05). A decision tree model including a decrease in LAA DF ≥ 6.61% during the first 20 min following pulmonary vein isolation (PVI) and a baseline RAA DF <5.6 Hz predicted long-term SR restoration with a sensitivity of 83% and a specificity of 93% (p < 0.05).Conclusion: This study found that high baseline DF values are predictive of unfavorable ablation outcomes. The reduction of the LAA DF at early ablation steps following PVI is associated with procedural AF termination and long-term SR maintenance.

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Section: Patient Population and Ablation Proceduresmentioning

confidence: 99%

Section: Electrophysiological Studymentioning

confidence: 99%

Section: Data Processingmentioning

confidence: 99%

Section: High Baseline Df and Negative Laa-to-raa Df Gradient Are Predictive Of Unfavorable Procedural Ablation Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dynamics of Intraprocedural Dominant Frequency Identifies Ablation Outcome in Persistent Atrial Fibrillation

et al. 2021

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Evaluation and optimization of novel extraction algorithms for the automatic detection of atrial activations recorded within the pulmonary veins during atrial fibrillation

Prudat

Luca

Yazdani

et al. 2022

BMC Med Inform Decis Mak

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Background and objective The automated detection of atrial activations (AAs) recorded from intracardiac electrograms (IEGMs) during atrial fibrillation (AF) is challenging considering their various amplitudes, morphologies and cycle length. Activation time estimation is further complicated by the constant changes in the IEGM active zones in complex and/or fractionated signals. We propose a new method which provides reliable automatic extraction of intracardiac AAs recorded within the pulmonary veins during AF and an accurate estimation of their local activation times. Methods First, two recently developed algorithms were evaluated and optimized on 118 recordings of pulmonary vein IEGM taken from 35 patients undergoing ablation of persistent AF. The adaptive mathematical morphology algorithm (AMM) uses an adaptive structuring element to extract AAs based on their morphological features. The relative-energy algorithm (Rel-En) uses short- and long-term energies to enhance and detect the AAs in the IEGM signals. Second, following the AA extraction, the signal amplitude was weighted using statistics of the AA sequences in order to reduce over- and undersensing of the algorithms. The detection capacity of our algorithms was compared with manually annotated activations and with two previously developed algorithms based on the Teager–Kaiser energy operator and the AF cycle length iteration, respectively. Finally, a method based on the barycenter was developed to reduce artificial variations in the activation annotations of complex IEGM signals. Results The best detection was achieved using Rel-En, yielding a false negative rate of 0.76% and a false positive rate of only 0.12% (total error rate 0.88%) against expert annotation. The post-processing further reduced the total error rate of the Rel-En algorithm by 70% (yielding to a final total error rate of 0.28%). Conclusion The proposed method shows reliable detection and robust temporal annotation of AAs recorded within pulmonary veins in AF. The method has low computational cost and high robustness for automatic detection of AAs, which makes it a suitable approach for online use in a procedural context.

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Remodeling in Persistent Atrial Fibrillation: Pathophysiology and Therapeutic Targets—A Systematic Review

Roka

Burright

2023

Physiologia

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Atrial fibrillation (AF) is characterized by disorganized rapid atrial electrical activity, which leads to impaired atrial function, adverse hemodynamic effects, and increased thromboembolic risk. The paroxysmal forms of AF can be effectively treated with current pharmacological and non-pharmacological modalities by targeting the arrhythmia triggers. Persistent AF, however, is more difficult to treat due to remodeling processes which may become major factors in the maintenance of the arrhythmia, rendering trigger-targeting treatment options less effective. We will systematically review the recent findings of the development and maintenance of persistent AF, including genetic, cellular, organ level, and systemic processes. As AF remains the most common sustained arrhythmia with the ongoing need to find effective treatment, we will also discuss potential treatment options targeting the remodeling processes.

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Severe and uniform bi-atrial remodeling measured by dominant frequency analysis in persistent atrial fibrillation unresponsive to ablation

Cited by 3 publications

References 30 publications

Dynamics of Intraprocedural Dominant Frequency Identifies Ablation Outcome in Persistent Atrial Fibrillation

Dynamics of Intraprocedural Dominant Frequency Identifies Ablation Outcome in Persistent Atrial Fibrillation

Evaluation and optimization of novel extraction algorithms for the automatic detection of atrial activations recorded within the pulmonary veins during atrial fibrillation

Remodeling in Persistent Atrial Fibrillation: Pathophysiology and Therapeutic Targets—A Systematic Review

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