Abstract
Background and ObjectiveOptimal targets for persistent atrial fibrillation (persAF) ablation are still debated. Atrial regions hosting high dominant frequency (HDF) are believed to participate in the initiation and maintenance of persAF and hence are potential targets for ablation, while rotor ablation has shown promising initial results. Currently, no commercially available system offers the capability to automatically identify both these phenomena. This paper describes an integrated 3D software platform combining the mapping of both frequency spectrum and phase from atrial electrograms (AEGs) to help guide persAF ablation in clinical cardiac electrophysiological studies. Methods30s of 2048 non-contact AEGs (EnSite Array, St. Jude Medical) were collected and analyzed per patient. After QRST removal, the AEGs were divided into 4s windows with a 50% overlap. Fast Fourier transform was used for DF identification. HDF areas were identified as the maximum DF to 0.25Hz below that, and their centers of gravity (CGs) were used to track their spatiotemporal movement. Spectral organization measurements were estimated. Hilbert transform was used to calculate instantaneous phase. ResultsThe system was successfully used to guide catheter ablation for 10 persAF patients. The mean processing time was 10.4 ± 1.5min, which is adequate comparing to the normal electrophysiological (EP) procedure time (120∼180min). ConclusionsA customized software platform capable of measuring different forms of spatiotemporal AEG analysis was implemented and used in clinical environment to guide persAF ablation. The modular nature of the platform will help electrophysiological studies in understanding of the underlying AF mechanisms.
Highlights
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia found in the clinical practice, affecting around 1% of the general population [1]
We developed and validated the first software platform that investigates multiple forms of spatiotemporal atrial electrograms (AEGs) features, such as frequency and phase analysis that can be used during the EP procedure, to help guide catheter ablation in persistent atrial fibrillation (persAF) patients [29]
Our results show that the overall processing time of the USURP-graphic user interface (GUI) for 30 s segments of the 2048 channels of AEGs is relatively short compared to the total time of catheter ablation procedures for complex persAF [50]
Summary
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia found in the clinical practice, affecting around 1% of the general population [1]. Electrophysiological (EP) studies have shown that structural and electrical remodeling in the atrial tissue are induced by sustained AF. The atrial regions hosting such behaviors are important in the initiation and perpetuation of the arrhythmia [5, 6]. Optimal targets for persistent atrial fibrillation (persAF) ablation are still debated. Atrial regions hosting high dominant frequency (HDF) are believed to participate in the initiation and maintenance of persAF and are potential targets for ablation, while rotor ablation has shown promising initial results. This paper describes an integrated 3D software platform combining the mapping of both frequency spectrum and phase from atrial electrograms (AEGs) to help guide persAF ablation in clinical cardiac electrophysiological studies
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