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A Novel Assessment of the Temporal Variation in the Fractionated Electrograms Using a Histogram Analysis of the Local Fractionation Interval in Persistent Atrial Fibrillation Patients.
MedLine Citation:
PMID:  22832674     Owner:  NLM     Status:  Publisher    
BACKGROUND: -The characteristics of atrial electrograms associated with atrial fibrillation (AF) termination are controversial. We investigated the electrogram characteristics that indicate procedural AF termination during continuous complex fractionated electrogram (CFE) ablation. METHODS AND RESULTS: -Fifty-two consecutive persistent AF patients (47 males, 54 ± 9 years) who underwent electrogram-based catheter ablation in the left atrium and coronary sinus following pulmonary vein isolation (PVI) were enrolled. The intracardiac bipolar atrial electrogram recordings were characterized by (1) fractionation interval (FI) analysis (>6s), (2) kurtosis (shape of the FI histogram), and (3) skewness (asymmetry of the FI histogram). Sites showing CFEs (mean FI ≤60 ms) were targeted, and AF was terminated in 20 patients (38%) after the PVI. The conventional CFE sites (mean ≤ 120 ms) in the patients with AF termination exhibited higher median kurtosis (2.69 (IQR 2.03-3.46) vs. 2.35 (IQR 1.79-2.48), P = 0.024) and higher CFE-mean interval (102.7±19.8 vs. 87.7±15.0, P = 0.008) than the patients without AF termination. Moreover, the AF termination sites had higher median kurtosis than the targeted sites without AF termination (5.13 (IQR 3.51-6.47) vs. 4.18 (IQR 2.91-5.34), P < 0.01) in patients with procedural termination. In addition, patients with AF termination had a higher sinus rhythm maintenance rate after a single procedure than patients without AF termination (Log-rank test, P = 0.007). CONCLUSIONS: -A kurtosis analysis using the FI histogram may be a useful tool for identifying the critical substrate for persistent AF and potential responders to catheter ablation.
Yenn-Jiang Lin; Kazuyoshi Suenari; Men-Tzung Lo; Chen Lin; Wan-Hsin Hsieh; Shih-Lin Chang; Li-Wei Lo; Yu-Feng Hu; Chen-Chuan Cheng; Yasuki Kihara; Tze-Fan Chao; Beny Hartono; Tsu-Juey Wu; Wei-Shiang Lin; Ke-Hsin Hsu; Ambrose S Kibos; Norden E Huang; Shih-Ann Chen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-25
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  -     ISSN:  1941-3084     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1 Taipei Veterans General Hospital & National Yang-Ming University, Taipei, Taiwan;
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