Relationship among complex signals, short cycle length activity, and dominant frequency in patients with long-lasting persistent AF: A high-density epicardial mapping study in humans

Geoffrey Lee, Kurt Roberts-Thomson, Andrew Madry, Steven Spence, Andrew Teh, Patrick M. Heck, Saurabh Kumar, Peter M. Kistler, Joseph B. Morton, Prashanthan Sanders, Jonathan M. Kalman

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background: Complex fractionated atrial electrograms (CFAEs) and regions of high dominant frequency (DF) both may identify sites critical to the maintenance of atrial fibrillation (AF). CFAEs may be defined by either (1) complex multicomponent electrograms (EGMs) and/or continuous electrical activity (multicomponent/continuous EGM) or (2) discrete high-frequency EGMs. Objective: The purpose of this study was to test if the 2 definitions of CFAE identify the same arrhythmia substrate and determine the relationship of CFAE to areas of high DF. Methods: High-density epicardial mapping of the posterior left atrium was performed in 10 patients with long-lasting persistent AF. Point-by-point analysis was performed to determine the spatial distribution and correlation of CFAE defined as either (1) multicomponent/continuous-EGMs or (2) AF cycle length <120 ms. Additionally, spatial analysis was performed to determine the relationship of high DF sites to CFAE sites defined by each of the 2 definitions. Results: The percentage of sites deemed CFAE varied markedly between patients and was different depending on the definition of CFAE adopted. There was a poor correlation between CFAE defined by multicomponent/continuous EGMs and AF cycle length <120 ms (r = 0.18). High DF sites were arranged in clusters evenly distributed throughout the posterior left atrium, with 4.2 ± 1.0 high DF clusters per patient. Although there was poor point-by-point correlation between multicomponent/continuous EGMs and high DF sites (r = 0.107), spatial analysis revealed that 96% of multicomponent/ continuous EGMs were found adjacent to and partially surrounding (≤5 mm) high DF sites. Conclusion: There is poor anatomic overlap between CFAE defined by multicomponent/continuous EGMs and CFAE defined by AF cycle length <120 ms. Multicomponent/continuous EGMs are found adjacent to and surrounding sites of high DF. Further studies are needed to determine the mechanisms responsible for these different signals.

LanguageEnglish
Pages1714-1719
Number of pages6
JournalHeart Rhythm
Volume8
Issue number11
DOIs
Publication statusPublished - 1 Nov 2011

Keywords

  • Atrial fibrillation
  • Complex fractionated atrial electrogram
  • Dominant frequency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Lee, Geoffrey ; Roberts-Thomson, Kurt ; Madry, Andrew ; Spence, Steven ; Teh, Andrew ; Heck, Patrick M. ; Kumar, Saurabh ; Kistler, Peter M. ; Morton, Joseph B. ; Sanders, Prashanthan ; Kalman, Jonathan M. / Relationship among complex signals, short cycle length activity, and dominant frequency in patients with long-lasting persistent AF : A high-density epicardial mapping study in humans. In: Heart Rhythm. 2011 ; Vol. 8, No. 11. pp. 1714-1719.
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abstract = "Background: Complex fractionated atrial electrograms (CFAEs) and regions of high dominant frequency (DF) both may identify sites critical to the maintenance of atrial fibrillation (AF). CFAEs may be defined by either (1) complex multicomponent electrograms (EGMs) and/or continuous electrical activity (multicomponent/continuous EGM) or (2) discrete high-frequency EGMs. Objective: The purpose of this study was to test if the 2 definitions of CFAE identify the same arrhythmia substrate and determine the relationship of CFAE to areas of high DF. Methods: High-density epicardial mapping of the posterior left atrium was performed in 10 patients with long-lasting persistent AF. Point-by-point analysis was performed to determine the spatial distribution and correlation of CFAE defined as either (1) multicomponent/continuous-EGMs or (2) AF cycle length <120 ms. Additionally, spatial analysis was performed to determine the relationship of high DF sites to CFAE sites defined by each of the 2 definitions. Results: The percentage of sites deemed CFAE varied markedly between patients and was different depending on the definition of CFAE adopted. There was a poor correlation between CFAE defined by multicomponent/continuous EGMs and AF cycle length <120 ms (r = 0.18). High DF sites were arranged in clusters evenly distributed throughout the posterior left atrium, with 4.2 ± 1.0 high DF clusters per patient. Although there was poor point-by-point correlation between multicomponent/continuous EGMs and high DF sites (r = 0.107), spatial analysis revealed that 96{\%} of multicomponent/ continuous EGMs were found adjacent to and partially surrounding (≤5 mm) high DF sites. Conclusion: There is poor anatomic overlap between CFAE defined by multicomponent/continuous EGMs and CFAE defined by AF cycle length <120 ms. Multicomponent/continuous EGMs are found adjacent to and surrounding sites of high DF. Further studies are needed to determine the mechanisms responsible for these different signals.",
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Lee, G, Roberts-Thomson, K, Madry, A, Spence, S, Teh, A, Heck, PM, Kumar, S, Kistler, PM, Morton, JB, Sanders, P & Kalman, JM 2011, 'Relationship among complex signals, short cycle length activity, and dominant frequency in patients with long-lasting persistent AF: A high-density epicardial mapping study in humans', Heart Rhythm, vol. 8, no. 11, pp. 1714-1719. https://doi.org/10.1016/j.hrthm.2011.05.021

Relationship among complex signals, short cycle length activity, and dominant frequency in patients with long-lasting persistent AF : A high-density epicardial mapping study in humans. / Lee, Geoffrey; Roberts-Thomson, Kurt; Madry, Andrew; Spence, Steven; Teh, Andrew; Heck, Patrick M.; Kumar, Saurabh; Kistler, Peter M.; Morton, Joseph B.; Sanders, Prashanthan; Kalman, Jonathan M.

In: Heart Rhythm, Vol. 8, No. 11, 01.11.2011, p. 1714-1719.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Relationship among complex signals, short cycle length activity, and dominant frequency in patients with long-lasting persistent AF

T2 - Heart Rhythm

AU - Lee, Geoffrey

AU - Roberts-Thomson, Kurt

AU - Madry, Andrew

AU - Spence, Steven

AU - Teh, Andrew

AU - Heck, Patrick M.

AU - Kumar, Saurabh

AU - Kistler, Peter M.

AU - Morton, Joseph B.

AU - Sanders, Prashanthan

AU - Kalman, Jonathan M.

PY - 2011/11/1

Y1 - 2011/11/1

N2 - Background: Complex fractionated atrial electrograms (CFAEs) and regions of high dominant frequency (DF) both may identify sites critical to the maintenance of atrial fibrillation (AF). CFAEs may be defined by either (1) complex multicomponent electrograms (EGMs) and/or continuous electrical activity (multicomponent/continuous EGM) or (2) discrete high-frequency EGMs. Objective: The purpose of this study was to test if the 2 definitions of CFAE identify the same arrhythmia substrate and determine the relationship of CFAE to areas of high DF. Methods: High-density epicardial mapping of the posterior left atrium was performed in 10 patients with long-lasting persistent AF. Point-by-point analysis was performed to determine the spatial distribution and correlation of CFAE defined as either (1) multicomponent/continuous-EGMs or (2) AF cycle length <120 ms. Additionally, spatial analysis was performed to determine the relationship of high DF sites to CFAE sites defined by each of the 2 definitions. Results: The percentage of sites deemed CFAE varied markedly between patients and was different depending on the definition of CFAE adopted. There was a poor correlation between CFAE defined by multicomponent/continuous EGMs and AF cycle length <120 ms (r = 0.18). High DF sites were arranged in clusters evenly distributed throughout the posterior left atrium, with 4.2 ± 1.0 high DF clusters per patient. Although there was poor point-by-point correlation between multicomponent/continuous EGMs and high DF sites (r = 0.107), spatial analysis revealed that 96% of multicomponent/ continuous EGMs were found adjacent to and partially surrounding (≤5 mm) high DF sites. Conclusion: There is poor anatomic overlap between CFAE defined by multicomponent/continuous EGMs and CFAE defined by AF cycle length <120 ms. Multicomponent/continuous EGMs are found adjacent to and surrounding sites of high DF. Further studies are needed to determine the mechanisms responsible for these different signals.

AB - Background: Complex fractionated atrial electrograms (CFAEs) and regions of high dominant frequency (DF) both may identify sites critical to the maintenance of atrial fibrillation (AF). CFAEs may be defined by either (1) complex multicomponent electrograms (EGMs) and/or continuous electrical activity (multicomponent/continuous EGM) or (2) discrete high-frequency EGMs. Objective: The purpose of this study was to test if the 2 definitions of CFAE identify the same arrhythmia substrate and determine the relationship of CFAE to areas of high DF. Methods: High-density epicardial mapping of the posterior left atrium was performed in 10 patients with long-lasting persistent AF. Point-by-point analysis was performed to determine the spatial distribution and correlation of CFAE defined as either (1) multicomponent/continuous-EGMs or (2) AF cycle length <120 ms. Additionally, spatial analysis was performed to determine the relationship of high DF sites to CFAE sites defined by each of the 2 definitions. Results: The percentage of sites deemed CFAE varied markedly between patients and was different depending on the definition of CFAE adopted. There was a poor correlation between CFAE defined by multicomponent/continuous EGMs and AF cycle length <120 ms (r = 0.18). High DF sites were arranged in clusters evenly distributed throughout the posterior left atrium, with 4.2 ± 1.0 high DF clusters per patient. Although there was poor point-by-point correlation between multicomponent/continuous EGMs and high DF sites (r = 0.107), spatial analysis revealed that 96% of multicomponent/ continuous EGMs were found adjacent to and partially surrounding (≤5 mm) high DF sites. Conclusion: There is poor anatomic overlap between CFAE defined by multicomponent/continuous EGMs and CFAE defined by AF cycle length <120 ms. Multicomponent/continuous EGMs are found adjacent to and surrounding sites of high DF. Further studies are needed to determine the mechanisms responsible for these different signals.

KW - Atrial fibrillation

KW - Complex fractionated atrial electrogram

KW - Dominant frequency

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U2 - 10.1016/j.hrthm.2011.05.021

DO - 10.1016/j.hrthm.2011.05.021

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