Characterization of electrograms associated with termination of chronic atrial fibrillation by catheter ablation
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Characterization of electrograms associated with termination of chronic atrial fibrillation by catheter ablation. / Takahashi, Yoshihide; O'Neill, Mark D; Hocini, Mélèze; Dubois, Rémi; Matsuo, Seiichiro; Knecht, Sébastien; Mahapatra, Srijoy; Lim, Kang-Teng; Jaïs, Pierre; Jonsson, Anders; Sacher, Frédéric; Sanders, Prashanthan; Rostock, Thomas; Bordachar, Pierre; Clémenty, Jacques; Klein, George J; Haïssaguerre, Michel.
in: J AM COLL CARDIOL, Jahrgang 51, Nr. 10, 10, 11.03.2008, S. 1003-1010.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Characterization of electrograms associated with termination of chronic atrial fibrillation by catheter ablation
AU - Takahashi, Yoshihide
AU - O'Neill, Mark D
AU - Hocini, Mélèze
AU - Dubois, Rémi
AU - Matsuo, Seiichiro
AU - Knecht, Sébastien
AU - Mahapatra, Srijoy
AU - Lim, Kang-Teng
AU - Jaïs, Pierre
AU - Jonsson, Anders
AU - Sacher, Frédéric
AU - Sanders, Prashanthan
AU - Rostock, Thomas
AU - Bordachar, Pierre
AU - Clémenty, Jacques
AU - Klein, George J
AU - Haïssaguerre, Michel
PY - 2008/3/11
Y1 - 2008/3/11
N2 - OBJECTIVES: This study sought to determine the characteristics of atrial electrograms predictive of slowing or termination of atrial fibrillation (AF) during ablation of chronic AF.BACKGROUND: There is growing recognition of a role for electrogram-based ablation.METHODS: Forty consecutive patients (34 male, 59 +/- 10 years) undergoing ablation for chronic AF persisting for a median of 12 months (range 1 to 84 months) were included. After pulmonary vein isolation and roof line ablation, electrogram-based ablation was performed in the left atrium and coronary sinus. Targeted electrograms were acquired in a 4-s window and characterized by: 1) percentage of continuous electrical activity; 2) bipolar voltage; 3) dominant frequency; 4) fractionation index; 5) mean absolute value of derivatives of electrograms; 6) local cycle length; and 7) presence of a temporal gradient of activation. Electrogram characteristics at favorable ablation regions, defined as those associated with slowing (a >or=6-ms increase in AF cycle length) or termination of AF were compared with those at unfavorable regions.RESULTS: The AF was terminated by electrogram-based ablation in 29 patients (73%) after targeting a total of 171 regions. Ablation at 37 (22%) of these regions was followed by AF slowing, and at 29 (17%) by AF termination. The percentage of continuous electrical activity and the presence of a temporal gradient of activation were independent predictors of favorable ablation regions (p = 0.016 and p = 0.038, respectively). Other electrogram characteristics at favorable ablation regions were not significantly different from those at unfavorable ablation regions.CONCLUSIONS: Catheter ablation at sites displaying a greater percentage of continuous activity or a temporal activation gradient is associated with slowing or termination of chronic AF.
AB - OBJECTIVES: This study sought to determine the characteristics of atrial electrograms predictive of slowing or termination of atrial fibrillation (AF) during ablation of chronic AF.BACKGROUND: There is growing recognition of a role for electrogram-based ablation.METHODS: Forty consecutive patients (34 male, 59 +/- 10 years) undergoing ablation for chronic AF persisting for a median of 12 months (range 1 to 84 months) were included. After pulmonary vein isolation and roof line ablation, electrogram-based ablation was performed in the left atrium and coronary sinus. Targeted electrograms were acquired in a 4-s window and characterized by: 1) percentage of continuous electrical activity; 2) bipolar voltage; 3) dominant frequency; 4) fractionation index; 5) mean absolute value of derivatives of electrograms; 6) local cycle length; and 7) presence of a temporal gradient of activation. Electrogram characteristics at favorable ablation regions, defined as those associated with slowing (a >or=6-ms increase in AF cycle length) or termination of AF were compared with those at unfavorable regions.RESULTS: The AF was terminated by electrogram-based ablation in 29 patients (73%) after targeting a total of 171 regions. Ablation at 37 (22%) of these regions was followed by AF slowing, and at 29 (17%) by AF termination. The percentage of continuous electrical activity and the presence of a temporal gradient of activation were independent predictors of favorable ablation regions (p = 0.016 and p = 0.038, respectively). Other electrogram characteristics at favorable ablation regions were not significantly different from those at unfavorable ablation regions.CONCLUSIONS: Catheter ablation at sites displaying a greater percentage of continuous activity or a temporal activation gradient is associated with slowing or termination of chronic AF.
KW - Anti-Arrhythmia Agents/therapeutic use
KW - Atrial Fibrillation/drug therapy
KW - Catheter Ablation
KW - Electrocardiography
KW - Electrophysiologic Techniques, Cardiac
KW - Female
KW - Heart Diseases/complications
KW - Humans
KW - Male
KW - Middle Aged
U2 - 10.1016/j.jacc.2007.10.056
DO - 10.1016/j.jacc.2007.10.056
M3 - SCORING: Journal article
C2 - 18325439
VL - 51
SP - 1003
EP - 1010
JO - J AM COLL CARDIOL
JF - J AM COLL CARDIOL
SN - 0735-1097
IS - 10
M1 - 10
ER -