Surface ECG and intracardiac spectral measures predict atrial fibrillation recurrence after catheter ablation
| Autor: | Vasanth Vedantham, Tomos E. Walters, Zian H. Tseng, Randall J. Lee, Joshua D. Moss, Nitish Badhwar, Judit Szilagyi, Gregory M. Marcus, Byron K. Lee, Edward P. Gerstenfeld |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment 0206 medical engineering Area under the curve Catheter ablation Atrial fibrillation 02 engineering and technology 030204 cardiovascular system & hematology Ablation medicine.disease 020601 biomedical engineering Intracardiac injection Pulmonary vein 03 medical and health sciences 0302 clinical medicine Text mining Physiology (medical) Internal medicine Cardiology Medicine Cardiology and Cardiovascular Medicine business Coronary sinus |
| Zdroj: | Journal of Cardiovascular Electrophysiology. 29:1371-1378 |
| ISSN: | 1045-3873 |
| DOI: | 10.1111/jce.13699 |
| Popis: | IntroductionOutcome of patients undergoing catheter ablation of atrial fibrillation (AF) varies widely. We sought to investigate whether parameters derived from the spectral analysis of surface ECG and intracardiac AF electrograms can predict outcome in patients referred for pulmonary vein isolation (PVI).MethodsResultsWe performed spectral analysis on the surface ECG and intracardiac electrograms from patients referred for AF ablation. After filtering and QRST subtraction, we measured the dominant frequency (DF), regularity index (RI) and the organizational index (OI) of fibrillatory electrograms and determined their value for predicting AF recurrence after ablation. A subjective, blinded prediction based on the surface ECG was also performed.We analyzed data from 153 PVI procedures in 140 patients (67.1% with persistent or longstanding AF). In a multivariable model, DF in the right atrium (RA) and distal coronary sinus (CSd)-to-RA DF gradient predicted AF recurrence (OR, 3.52, P=0.023 and OR, 0.2, P=0.034, respectively). DF in RA and CSd to RA DF gradient had a good predictive value for PVI outcome (area under the curve [AUC] of 0.73, P=0.007 and 0.74, P=0.007, respectively). These performed better than the subjective predictions of experienced electrophysiologists (P=0.2).ConclusionsHigher RA DF, lower CSd to RA DF gradient predicted recurrence after AF ablation. These spectral measures suggest a more remodeled atrial substrate and may provide simple tools for risk stratification or predict the need for additional substrate modification in patients referred for AF ablation. |
| Databáze: | OpenAIRE |
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