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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, Vol. 12, No. 7, 07.2015, p. 1415-1423.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Lau, DH, Maesen, B, Zeemering, S, Kuklik, P, van Hunnik, A, Lankveld, TAR, Bidar, E, Verheule, S, Nijs, J, Maessen, J, Crijns, H, Sanders, P & Schotten, U 2015, 'Indices of bipolar complex fractionated atrial electrograms correlate poorly with each other and atrial fibrillation substrate complexity', HEART RHYTHM, vol. 12, no. 7, pp. 1415-1423. https://doi.org/10.1016/j.hrthm.2015.03.017

APA

Lau, D. H., Maesen, B., Zeemering, S., Kuklik, P., van Hunnik, A., Lankveld, T. A. R., Bidar, E., Verheule, S., Nijs, J., Maessen, J., Crijns, H., Sanders, P., & Schotten, U. (2015). Indices of bipolar complex fractionated atrial electrograms correlate poorly with each other and atrial fibrillation substrate complexity. HEART RHYTHM, 12(7), 1415-1423. https://doi.org/10.1016/j.hrthm.2015.03.017

Vancouver

Lau DH, Maesen B, Zeemering S, Kuklik P, van Hunnik A, Lankveld TAR et al. Indices of bipolar complex fractionated atrial electrograms correlate poorly with each other and atrial fibrillation substrate complexity. HEART RHYTHM. 2015 Jul;12(7):1415-1423. https://doi.org/10.1016/j.hrthm.2015.03.017

Bibtex

@article{3ce68d83fed44107b890916ce3462b93,
title = "Indices of bipolar complex fractionated atrial electrograms correlate poorly with each other and atrial fibrillation substrate complexity",
abstract = "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.",
keywords = "Aged, Algorithms, Atrial Fibrillation/diagnosis, Cardiac Catheters, Cardiac Electrophysiology/methods, Catheter Ablation/adverse effects, Electrophysiologic Techniques, Cardiac/instrumentation, Female, Heart Conduction System/pathology, Humans, Male, Middle Aged, Reproducibility of Results, Statistics as Topic",
author = "Lau, {Dennis H} and Bart Maesen and Stef Zeemering and Pawel Kuklik and {van Hunnik}, Arne and Lankveld, {Theodorus A R} and Elham Bidar and Sander Verheule and Jan Nijs and Jos Maessen and Harry Crijns and Prashanthan Sanders and Ulrich Schotten",
note = "Copyright {\textcopyright} 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.",
year = "2015",
month = jul,
doi = "10.1016/j.hrthm.2015.03.017",
language = "English",
volume = "12",
pages = "1415--1423",
journal = "HEART RHYTHM",
issn = "1547-5271",
publisher = "Elsevier",
number = "7",

}

RIS

TY - JOUR

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 -