Abstract
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.
Highlights
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
The non-invasive Electrocardiographic Imaging (ECGI) AF rate map simultaneous to the basket recording (Figure 2B) shows a located fastest region (7 Hz). This region covers a larger region on ECGI than on intracardiac maps, extending to much of right atrium (RA) and the septal left atrium (LA)
We found agreement between intracardiac and non-invasive measures of dominant frequency during AF, that was dramatically improved by secondary markers of stability such as regularity index
Summary
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. The identification and elimination of regions of rapid atrial activity are plausible mechanistic sites and indicate drivers in optical imaging of human AF (Hansen et al, 2015) and clinical studies (Miller et al, 2017; Honarbakhsh et al, 2019). These fastest activated regions may lie near scar or fibrosis (Swartz et al, 2009), and can. Existing commercial ECGI systems use 252 leads which introduce practical limitations for bedside use, and increase the chance that electrodes may lose contact at some regions of the torso
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