Propagation of meandering rotors surrounded by areas of high dominant frequency in persistent atrial fibrillation

Salinet, J, Schlindwein, FS, Stafford, P, Almeida, TP, Li, X, Vanheusden, FJ ORCID: https://orcid.org/0000-0003-2369-6189, Guillem, MS and Ng, GA, 2017. Propagation of meandering rotors surrounded by areas of high dominant frequency in persistent atrial fibrillation. Heart Rhythm, 14 (9), pp. 1269-1278. ISSN 1547-5271

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Abstract

Background: Identification of arrhythmogenic regions remains a challenge in persistent atrial fibrillation (persAF). Frequency and phase analysis allows identification of potential ablation targets.

Objective: This study aimed to investigate the spatiotemporal association between dominant frequency (DF) and reentrant phase activation areas.

Methods: A total of 8 persAF patients undergoing first-time catheter ablation procedure were enrolled. A noncontact array catheter was deployed into the left atrium (LA) and 2048 atrial fibrillation electrograms (AEGs) were acquired for 15 seconds following ventricular far-field cancellation. DF and phase singularity (PS) points were identified from the AEGs and tracked over consecutive frames. The spatiotemporal correlation of high DF areas and PS points was investigated, and the organization index at the core of high-DF areas was compared with that of their periphery.

Results: The phase maps presented multiple simultaneous PS points that drift over the LA, with preferential locations. Regions displaying higher PS concentration showed a degree of colocalization with DF sites, with PS and DF regions being neighbors in 61.8% and with PS and DF regions overlapping in 36.8% of the time windows. Sites with highest DF showed a greater degree of organization at their core compared with their periphery. After ablation, the PS incidence reduced over the entire LA (36.2% ± 23.2%, P < .05), but especially at the pulmonary veins (78.6% ± 22.2%, P < .05).

Conclusion: Multiple PS points drifting over the LA were identified with their clusters correlating spatially with the DF regions. After pulmonary vein isolation, the PS’s complexity was reduced, which supports the notion that PS sites represent areas of relevance to the atrial substrate.

Item Type:	Journal article
Publication Title:	Heart Rhythm
Creators:	Salinet, J., Schlindwein, F.S., Stafford, P., Almeida, T.P., Li, X., Vanheusden, F.J., Guillem, M.S. and Ng, G.A.
Publisher:	Elsevier
Date:	September 2017
Volume:	14
Number:	9
ISSN:	1547-5271
Identifiers:	Number Type 10.1016/j.hrthm.2017.04.031 DOI S1547527117304976 Publisher Item Identifier
Rights:	© 2017 Heart Rhythm Society
Divisions:	Schools > School of Science and Technology
Record created by:	Jonathan Gallacher
Date Added:	29 Nov 2018 09:12
Last Modified:	29 Nov 2018 09:12
URI:	https://irep.ntu.ac.uk/id/eprint/35163

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