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Complex electrograms within the coronary sinus: time- and frequency-domain characteristics, effects of antral pulmonary vein isolation, and relationship to clinical outcome in patients with paroxysmal and persistent atrial fibrillation.

Coronary Sinus Electrograms in Atrial Fibrillation. Background: The mechanistic and clinical significance of complex fractionated atrial electrograms (CFAE) in the coronary sinus (CS) has been unclear.Methods and Results: Antral pulmonary vein isolation (APVI) was performed in 77 patients with parox...

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Published in:Journal of Cardiovascular Electrophysiology Vol. 19; no. 10; pp. 1017 - 1024
Main Authors: Yoshida K, Ulfarsson M, Tada H, Chugh A, Good E, Kuhne M, Crawford T, Sarrazin JF, Chalfoun N, Wells D, Jongnarangsin K, Pelosi F Jr., Bogun F, Morady F, Oral H
Format: research tables/charts tracings Journal Article
Published: Wiley-Blackwell Oct2008
Online Access:View this record in EBSCOhost
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      jtl: Journal of Cardiovascular Electrophysiology
      issn: 10453873
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    pubinfo:
      dt: Oct2008
      vid: 19
      iid: 10
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      pub: Wiley-Blackwell
      place: Malden, Massachusetts
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        105554994
        2010040654
        10.1111/j.1540-8167.2008.01175.x
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        atl: Complex electrograms within the coronary sinus: time- and frequency-domain characteristics, effects of antral pulmonary vein isolation, and relationship to clinical outcome in patients with paroxysmal and persistent atrial fibrillation.
      aug:
        au:
          Yoshida K
          Ulfarsson M
          Tada H
          Chugh A
          Good E
          Kuhne M
          Crawford T
          Sarrazin JF
          Chalfoun N
          Wells D
          Jongnarangsin K
          Pelosi F Jr.
          Bogun F
          Morady F
          Oral H
        affil: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
      sug:
        subj:
          Atrial Fibrillation
          Coronary Vessels
          Heart Conduction System Surgery
          Pulmonary Veins Surgery
          Aged
          Body Surface Potential Mapping
          Catheter Ablation
          Chi Square Test
          Chronic Disease
          Female
          Fisher's Exact Test
          Funding Source
          Male
          Middle Age
          Paired T-Tests
          Signal Processing, Computer Assisted
          T-Tests
          Treatment Outcomes
          Human
          Aged: 65+ years
          Middle Aged: 45-64 years
          Female
          Male
      ab: Coronary Sinus Electrograms in Atrial Fibrillation. Background: The mechanistic and clinical significance of complex fractionated atrial electrograms (CFAE) in the coronary sinus (CS) has been unclear.Methods and Results: Antral pulmonary vein isolation (APVI) was performed in 77 patients with paroxysmal (32) or persistent AF (45). CS electrograms recorded for 60 seconds before and after APVI were analyzed in the time- and frequency-domains. Dominant frequency (DF), complexity index (CI: change in polarity of depolarization), and fractionation index (FI: change in direction of depolarization slope) were determined. Before APVI, there was no difference in DF, CI, or FI between paroxysmal and persistent AF. APVI resulted in a significant decrease in DF, CI, and FI in all patients. Baseline CI (43±13/s vs 54±14/s, P = 0.03) and FI (64 ± 23/s vs 87 ± 30/s, P = 0.02) were lower in patients with paroxysmal AF who had AF terminated by ablation than who did not. At 10 ± 2 months, 69% of patients with paroxysmal AF and 49% of patients with persistent AF were free from AF after single ablation. Baseline CI was higher amongpatients with paroxysmal AF who had AF after APVI (56 ± 20/s vs 44 ± 10/s, P = 0.03). In patients with persistent AF, there was a larger decrease in DF after APVI among patients who remained free from AF (13 ± 11% vs 7 ± 9%, P < 0.05).Conclusions: Complexity of CS electrograms may reflect drivers of AF that perpetuate paroxysmal AF after APVI. In persistent AF, the extent to which APVI decreases DF in the CS correlates with efficacy, suggesting that DF identifies patients who may require additional ablation beyond APVI.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        tracings
        Journal Article
      ougenre: Article
    language: English
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