Indices of bipolar complex fractionated atrial electrograms correlate poorly with each other and atrial fibrillation substrate complexity
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Indices of bipolar complex fractionated atrial electrograms correlate poorly with each other and atrial fibrillation substrate complexity. / Lau, Dennis H; Maesen, Bart; Zeemering, Stef; Kuklik, Pawel; van Hunnik, Arne; Lankveld, Theodorus A R; Bidar, Elham; Verheule, Sander; Nijs, Jan; Maessen, Jos; Crijns, Harry; Sanders, Prashanthan; Schotten, Ulrich.
in: HEART RHYTHM, Jahrgang 12, Nr. 7, 07.2015, S. 1415-1423.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Indices of bipolar complex fractionated atrial electrograms correlate poorly with each other and atrial fibrillation substrate complexity
AU - Lau, Dennis H
AU - Maesen, Bart
AU - Zeemering, Stef
AU - Kuklik, Pawel
AU - van Hunnik, Arne
AU - Lankveld, Theodorus A R
AU - Bidar, Elham
AU - Verheule, Sander
AU - Nijs, Jan
AU - Maessen, Jos
AU - Crijns, Harry
AU - Sanders, Prashanthan
AU - Schotten, Ulrich
N1 - Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
PY - 2015/7
Y1 - 2015/7
N2 - BACKGROUND: The pathophysiological relevance of complex fractionated atrial electrograms (CFAE) in atrial fibrillation (AF) remains poorly understood.OBJECTIVE: The aim of this study was to comprehensively investigate how bipolar CFAE correlates with unipolar electrogram fractionation and the underlying electrophysiological substrate of AF.METHODS: Ten-second unipolar AF electrograms were recorded using a high-density electrode from the left atrium of 20 patients with AF (10 with persistent AF and 10 with paroxysmal AF) undergoing cardiac surgery. Semiautomated bipolar CFAE algorithms: complex fractionated electrogram-mean, interval confidence interval, continuous electrical activity, average complex interval, and shortest complex interval were evaluated against AF substrate complexity measures following fibrillation wave reconstruction derived from local unipolar activation time. The effect of interelectrode spacing and electrode orientation on bipolar CFAE was also examined.RESULTS: All 5 semiautomated bipolar CFAE algorithms showed poor correlation with each other and AF substrate complexity measures (conduction velocity, number of waves or breakthroughs per AF cycle, and electrical dissociation). Bipolar CFAE also correlated poorly with fractionation index derived from unipolar electrograms. Increased interelectrode spacing resulted in an increase in bipolar CFAE detected except for the interval confidence interval algorithm. CFAE appears unaffected by bipolar electrode orientation (vertical vs horizontal). By contrast, unipolar fractionation index correlated well with AF substrate complexity measures and can be regarded as a marker for conduction block.CONCLUSION: The lack of pathophysiological relevance of bipolar CFAE analysis may in part contribute to the divergent and limited success rates of catheter ablation strategies targeting CFAE.
AB - BACKGROUND: The pathophysiological relevance of complex fractionated atrial electrograms (CFAE) in atrial fibrillation (AF) remains poorly understood.OBJECTIVE: The aim of this study was to comprehensively investigate how bipolar CFAE correlates with unipolar electrogram fractionation and the underlying electrophysiological substrate of AF.METHODS: Ten-second unipolar AF electrograms were recorded using a high-density electrode from the left atrium of 20 patients with AF (10 with persistent AF and 10 with paroxysmal AF) undergoing cardiac surgery. Semiautomated bipolar CFAE algorithms: complex fractionated electrogram-mean, interval confidence interval, continuous electrical activity, average complex interval, and shortest complex interval were evaluated against AF substrate complexity measures following fibrillation wave reconstruction derived from local unipolar activation time. The effect of interelectrode spacing and electrode orientation on bipolar CFAE was also examined.RESULTS: All 5 semiautomated bipolar CFAE algorithms showed poor correlation with each other and AF substrate complexity measures (conduction velocity, number of waves or breakthroughs per AF cycle, and electrical dissociation). Bipolar CFAE also correlated poorly with fractionation index derived from unipolar electrograms. Increased interelectrode spacing resulted in an increase in bipolar CFAE detected except for the interval confidence interval algorithm. CFAE appears unaffected by bipolar electrode orientation (vertical vs horizontal). By contrast, unipolar fractionation index correlated well with AF substrate complexity measures and can be regarded as a marker for conduction block.CONCLUSION: The lack of pathophysiological relevance of bipolar CFAE analysis may in part contribute to the divergent and limited success rates of catheter ablation strategies targeting CFAE.
KW - Aged
KW - Algorithms
KW - Atrial Fibrillation/diagnosis
KW - Cardiac Catheters
KW - Cardiac Electrophysiology/methods
KW - Catheter Ablation/adverse effects
KW - Electrophysiologic Techniques, Cardiac/instrumentation
KW - Female
KW - Heart Conduction System/pathology
KW - Humans
KW - Male
KW - Middle Aged
KW - Reproducibility of Results
KW - Statistics as Topic
U2 - 10.1016/j.hrthm.2015.03.017
DO - 10.1016/j.hrthm.2015.03.017
M3 - SCORING: Journal article
C2 - 25771914
VL - 12
SP - 1415
EP - 1423
JO - HEART RHYTHM
JF - HEART RHYTHM
SN - 1547-5271
IS - 7
ER -