Journal of the American College of Cardiology · 2008
Characterization of electrograms associated with termination of chronic atrial fibrillation by catheter ablation.
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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
Аннотация
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.
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.