The temporal behavior and consistency of bipolar atrial electrograms in human persistent atrial fibrillation

Author(s)

Almeida, Tiago P. ^{[1, 2]} ; Chu, Gavin S. ^{[3, 4]} ; Bell, Michael J. ^[1] ; Li, Xin ^{[1, 5]} ; Salinet, Joao L. ^[2] ; Dastagir, Nawshin ^[3] ; Tuan, Jiun H. ^[4] ; Stafford, Peter J. ^[4] ; Ng, G. Andre ^{[3, 5, 4]} ; Schlindwein, Fernando S. ^{[1, 5]}

Affiliation

^[1] Univ Leicester, Dept Engn, Univ Rd, Leicester LE1 7RH, Leics - England

^[2] Fed ABC Univ, Engn Modelling & Appl Social Sci Ctr, Santo Andre - Brazil

^[3] Univ Leicester, Dept Cardiovasc Sci, Leicester, Leics - England

^[4] Univ Hosp Leicester NHS Trust, Leicester, Leics - England

^[5] Glenfield Hosp, Natl Inst Hlth Res, Leicester Cardiovasc Biomed Res Ctr, Leicester, Leics - England

• Document type: Journal article
• Source: MEDICAL & BIOLOGICAL ENGINEERING & COMPUTING; v. 56, n. 1, p. 71-83, JAN 2018.
• Web of Science Citations: 2

Abstract

The unstable temporal behavior of atrial electrical activity during persistent atrial fibrillation (persAF) might influence ablation target identification, which could explain the conflicting persAF ablation outcomes in previous studies. We sought to investigate the temporal behavior and consistency of atrial electrogram (AEG) fractionation using different segment lengths. Seven hundred ninety-seven bipolar AEGs were collected with three segment lengths (2.5, 5,and 8 s) from 18 patients undergoing persAF ablation. The AEGs with 8-s duration were divided into three 2.5-s consecutive segments. AEG fractionation classification was applied off-line to all cases following the CARTO criteria; 43% of the AEGs remained fractionated for the three consecutive AEG segments, while nearly 30% were temporally unstable. AEG classification within the consecutive segments had moderate correlation (segment 1 vs 2: Spearman's correlation rho = 0.74, kappa score kappa = 0.62; segment 1 vs 3: rho = 0.726, kappa = 0.62; segment 2 vs 3: rho = 0.75, kappa = 0.68). AEG classifications were more similar between AEGs with 5 and 8 s (rho = 0.96, kappa = 0.87) than 2.5 versus 5 s (rho = 0.93, kappa = 0.84) and 2.5 versus 8 s (rho = 0.90, kappa = 0.78). Our results show that the CARTO criteria should be revisited and consider recording duration longer than 2.5 s for consistent ablation target identification in persAF. (AU)

• FAPESP's process: 14/26066-0 - Experimental study on analyzing the presence of arrhythmogenic substrates during ventricular circulatory support
• Grantee: João Loures Salinet Júnior
• Support Opportunities: Scholarships in Brazil - Post-Doctoral