Abstract
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.
Highlights
Pulmonary vein isolation has emerged as an effective treatment for patients suffering from paroxysmal atrial fibrillation (AF), while its success rate in persistent AF is significantly lower (Brooks et al, 2010)
This study has been performed within the framework of an ongoing project (REORGANIZE-AF) that is aimed at assessing the level of ECG and intracardiac electrogram (EGM) organization in persistent AF (peAF) to improve the selection of patients for ablation
High surface and intracardiac dominant frequency (DF) values and a negative left atrial appendage (LAA)-to-right atrial appendage (RAA) DF gradient before ablation are associated with the procedural failure to terminate AF
Summary
Pulmonary vein isolation has emerged as an effective treatment for patients suffering from paroxysmal atrial fibrillation (AF), while its success rate in persistent AF (peAF) is significantly lower (Brooks et al, 2010). 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. We hypothesized that combining baseline intracardiac DF and its time-course throughout an ablation may be used to track the efficacy of step-CA en route to long-term SR restoration in peAF. 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
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