scholarly journals Non-invasive Spatial Mapping of Frequencies in Atrial Fibrillation: Correlation With Contact Mapping

2021 ◽  
Vol 11 ◽  
Author(s):  
Miguel Rodrigo ◽  
Kian Waddell ◽  
Sarah Magee ◽  
Albert J. Rogers ◽  
Mahmood Alhusseini ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Dominant Frequency ◽  
Electrocardiographic Imaging ◽  
Distribution Maps ◽  
Contact Mapping ◽  
Non Invasive ◽  
Df Analysis ◽  
Ablation Success ◽  
Atrial Activation ◽  
Activation Rates

Introduction: Regional differences in activation rates may contribute to the electrical substrates that maintain atrial fibrillation (AF), and estimating them non-invasively may help guide ablation or select anti-arrhythmic medications. We tested whether non-invasive assessment of regional AF rate accurately represents intracardiac recordings.Methods: In 47 patients with AF (27 persistent, age 63 ± 13 years) we performed 57-lead non-invasive Electrocardiographic Imaging (ECGI) in AF, simultaneously with 64-pole intracardiac signals of both atria. ECGI was reconstructed by Tikhonov regularization. We constructed personalized 3D AF rate distribution maps by Dominant Frequency (DF) analysis from intracardiac and non-invasive recordings.Results: Raw intracardiac and non-invasive DF differed substantially, by 0.54 Hz [0.13 – 1.37] across bi-atrial regions (R2 = 0.11). Filtering by high spectral organization reduced this difference to 0.10 Hz (cycle length difference of 1 – 11 ms) [0.03 – 0.42] for patient-level comparisons (R2 = 0.62), and 0.19 Hz [0.03 – 0.59] and 0.20 Hz [0.04 – 0.61] for median and highest DF, respectively. Non-invasive and highest DF predicted acute ablation success (p = 0.04).Conclusion: Non-invasive estimation of atrial activation rates is feasible and, when filtered by high spectral organization, provide a moderate estimate of intracardiac recording rates in AF. Non-invasive technology could be an effective tool to identify patients who may respond to AF ablation for personalized therapy.

scholarly journals Non-Invasive Assessment of Complexity of Atrial Fibrillation: Correlation with Contact Mapping and Impact of Ablation

2020 ◽  
Author(s):  
Miguel Rodrigo ◽  
Andreu M. Climent ◽  
Ismael Hernández-Romero ◽  
Alejandro Liberos ◽  
Tina Baykaner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Surface ◽  
Response To Therapy ◽  
The Body ◽  
Surface Mapping ◽  
Electrocardiographic Imaging ◽  
Phase Singularity ◽  
Contact Mapping ◽  
Clinical Endpoints ◽  
Non Invasive

Background - It is difficult to non-invasively phenotype atrial fibrillation (AF) in a way that reflects clinical endpoints such as response to therapy. We set out to map electrical patterns of disorganization and regions of reentrant activity in AF from the body surface using electrocardiographic imaging (ECGI), calibrated to panoramic intracardiac recordings and referenced to AF termination by ablation. Methods - Bi-atrial intracardiac electrograms of 47 AF patients at ablation (30 persistent, 29 male, 63±9 years) were recorded with 64-pole basket catheters and simultaneous 57-lead body surface ECGs. Atrial epicardial electrical activity was reconstructed and organized sites were invasively and non-invasively tracked in 3D using phase singularity (PS). In a subset of 17 patients, sites of AF organization were targeted for ablation. Results - Body surface mapping showed greater AF organization near intracardially-detected drivers than elsewhere, both in PS density (2.3±2.1 vs 1.9±1.6, p=0.02) and number of drivers (3.2±2.3 vs 2.7±1.7, p=0.02). Complexity, defined as the number of stable AF reentrant sites, was concordant between non-invasive and invasive methods (r 2 =0.5, CC=0.71). In the subset receiving targeted ablation, AF complexity showed lower values in those in whom AF terminated than those in whom AF did not terminate (p<0.01). Conclusions - AF complexity tracked non-invasively correlates well with organized and disorganized regions detected by panoramic intracardiac mapping, and correlates with the acute outcome by ablation. This approach may assist in bedside monitoring of therapy or in improving the efficacy of ongoing ablation procedures.

scholarly journals Systematic differences of non-invasive dominant frequency estimation compared to invasive dominant frequency estimation in atrial fibrillation

2019 ◽  
Vol 104 ◽  
pp. 299-309 ◽  
Author(s):  
Frederique J. Vanheusden ◽  
Gavin S. Chu ◽  
Xin Li ◽  
João Salinet ◽  
Tiago P. Almeida ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Frequency Estimation ◽  
Dominant Frequency ◽  
Non Invasive

Abstract 4104: Organization of Atrial Signals is Critical Prior to Cardioversion of Atrial Fibrillation with Intravenous Flecainide: Insight from Spectral Analysis of Intracardiac Electrograms

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jiun Tuan ◽  
Suman Kundu ◽  
Mohamed Jeilan ◽  
Faizel Osman ◽  
Rajkumar Mantravadi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Spectral Analysis ◽  
Catheter Ablation ◽  
Cycle Length ◽  
Dominant Frequency ◽  
Relative Increase ◽  
Significant Difference ◽  
Before And After ◽  
Atrial Activation ◽  
Relative Change

Introduction & Hypothesis: Studies in catheter ablation of atrial fibrillation (AF) show that an increase in cycle length (CL) and higher organization index (OI) is associated with termination of AF. We hypothesize that similar changes can be seen in chemical cardioversion with Flecainide Methods: Patients who were still in AF at the end of catheter ablation for AF were given intravenous flecainide. OI and dominant frequency (DF) were obtained by Fast Fourier Transform of coronary sinus electrograms over 10s in AF, before and after flecainide infusion. Mean CL was also calculated. Results: 28 patients were identified (18 paroxysmal AF and 10 persistent AF). 8 cardioverted to sinus rhythm (SR) with flecainide. In all patients, mean CL increased from 211 ± 44 ms to 321 ± 85 ms (p <0.001). Mean DF decreased from 5.2 ± 1.03 Hz to 3.6 ± 1.04 Hz (p <0.001). Mean OI was 0.33 ± 0.13 before and 0.32 ± 0.11 after flecainide (p = 0.90). Comparing patients who cardioverted to SR with those who did not, OI post-flecainide was 0.41 ± 0.12 vs 0.29 ± 0.10 (p=0.013) and relative change in OI was 29 ± 33% vs −3.9 ± 27% (p=0.016) respectively. No significant difference was noted in the change in CL and DF in the 2 groups. Logistic regression showed that a greater relative increase in OI (p=0.04), a higher OI post-flecainide (p=0.03) and SR at start of procedure (p=0.03) are independently associated with cardioversion to SR with flecainide. Conclusion: Increase in OI, independent of changes to the CL and DF, appears critical to AF termination with flecainide. The increase in OI may reflect an increase in size and reduction in the number of re-entrant circuits, which together with slowing of atrial activation, result in return to SR.

scholarly journals Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study

Biology ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 838
Author(s):  
Ana María Sánchez de la Nava ◽  
Ana González Mansilla ◽  
Esteban González-Torrecilla ◽  
Pablo Ávila ◽  
Tomás Datino ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Computational Study ◽  
P Value ◽  
Electrocardiographic Imaging ◽  
Non Invasive ◽  
Electrical Modelling ◽  
One Year ◽  
Improve Patient ◽  
Af Recurrence

Current clinical guidelines establish Pulmonary Vein (PV) isolation as the indicated treatment for Atrial Fibrillation (AF). However, AF can also be triggered or sustained due to atrial drivers located elsewhere in the atria. We designed a new simulation workflow based on personalized computer simulations to characterize AF complexity of patients undergoing PV ablation, validated with non-invasive electrocardiographic imaging and evaluated at one year after ablation. We included 30 patients using atrial anatomies segmented from MRI and simulated an automata model for the electrical modelling, consisting of three states (resting, excited and refractory). In total, 100 different scenarios were simulated per anatomy varying rotor number and location. The 3 states were calibrated with Koivumaki action potential, entropy maps were obtained from the electrograms and compared with ECGi for each patient to analyze PV isolation outcome. The completion of the workflow indicated that successful AF ablation occurred in patients with rotors mainly located at the PV antrum, while unsuccessful procedures presented greater number of driving sites outside the PV area. The number of rotors attached to the PV was significantly higher in patients with favorable long-term ablation outcome (1-year freedom from AF: 1.61 ± 0.21 vs. AF recurrence: 1.40 ± 0.20; p-value = 0.018). The presented workflow could improve patient stratification for PV ablation by screening the complexity of the atria.

Atrial Activation Rates During Atrial Fibrillation and Left Atrial Diameter are the Strongest Predictors of Cardioversion Success

2008 ◽  
Vol 17 ◽  
pp. S166
Author(s):  
Christopher X. Wong ◽  
Anthony G. Brooks ◽  
Martin K. Stiles ◽  
Bobby John ◽  
Hany Dimitri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Diameter ◽  
Atrial Activation ◽  
Activation Rates

scholarly journals Automatic Extraction of Recurrent Patterns of High Dominant Frequency Mapping During Human Persistent Atrial Fibrillation

2021 ◽  
Vol 12 ◽  
Author(s):  
Xin Li ◽  
Gavin S. Chu ◽  
Tiago P. Almeida ◽  
Frederique J. Vanheusden ◽  
João Salinet ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Persistent Atrial Fibrillation ◽  
Dominant Frequency ◽  
Recognition Algorithm ◽  
Time Interval ◽  
Contact Mapping ◽  
Time Period ◽  
Before And After ◽  
Spatiotemporal Behavior ◽  
Recurrent Patterns

Purpose: Identifying targets for catheter ablation remains challenging in persistent atrial fibrillation (persAF). The dominant frequency (DF) of atrial electrograms during atrial fibrillation (AF) is believed to primarily reflect local activation. Highest DF (HDF) might be responsible for the initiation and perpetuation of persAF. However, the spatiotemporal behavior of DF remains not fully understood. Some DFs during persAF were shown to lack spatiotemporal stability, while others exhibit recurrent behavior. We sought to develop a tool to automatically detect recurrent DF patterns in persAF patients.Methods: Non-contact mapping of the left atrium (LA) was performed in 10 patients undergoing persAF HDF ablation. 2,048 virtual electrograms (vEGMs, EnSite Array, Abbott Laboratories, USA) were collected for up to 5 min before and after ablation. Frequency spectrum was estimated using fast Fourier transform and DF was identified as the peak between 4 and 10 Hz and organization index (OI) was calculated. The HDF maps were identified per 4-s window and an automated pattern recognition algorithm was used to find recurring HDF spatial patterns. Dominant patterns (DPs) were defined as the HDF pattern with the highest recurrence.Results: DPs were found in all patients. Patients in atrial flutter after ablation had a single DP over the recorded time period. The time interval (median [IQR]) of DP recurrence for the patients in AF after ablation (7 patients) decreased from 21.1 s [11.8 49.7 s] to 15.7 s [6.5 18.2 s]. The DF inside the DPs presented lower temporal standard deviation (0.18 ± 0.06 Hz vs. 0.29 ± 0.12 Hz, p &lt; 0.05) and higher OI (0.35 ± 0.03 vs. 0.31 ± 0.04, p &lt; 0.05). The atrial regions with the highest proportion of HDF region were the septum and the left upper pulmonary vein.Conclusion: Multiple recurrent spatiotemporal HDF patterns exist during persAF. The proposed method can identify and quantify the spatiotemporal repetition of the HDFs, where the high recurrences of DP may suggest a more organized rhythm. DPs presented a more consistent DF and higher organization compared with non-DPs, suggesting that DF with higher OI might be more likely to recur. Recurring patterns offer a more comprehensive dynamic insight of persAF behavior, and ablation targeting such regions may be beneficial.

scholarly journals A Wavelet-Based Method for Non-Invasive Dominant Frequency Detection in Atrial Fibrillation

2020 ◽  
Author(s):  
Victor Gonçalves Marques ◽  
Miguel Rodrigo ◽  
Maria de la Salud Guillem Sánchez ◽  
João Salinet
Keyword(s):  
Atrial Fibrillation ◽  
Dominant Frequency ◽  
Non Invasive ◽  
Frequency Detection
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