Relationship Between Complex Fractionated Electrograms (CFE) and Dominant Frequency (DF) Sites and Prospective Assessment of Adding DF-Guided Ablation to Pulmonary Vein Isolation in Persistent Atrial Fibrillation (AF).
Dominant Frequency Mapping and Ablation. Background: Sites of high DF are potential targets for AF ablation, but it is unknown if addition of DF ablation can improve procedural outcome. Objectives: We sought to (1) examine the relationship between DF sites and complex fractionated electrograms (CFE...
| Publicado en: | Journal of Cardiovascular Electrophysiology Vol. 22; no. 12; pp. 1309 - 1317 |
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| Autores principales: | , , , , , , , , , |
| Formato: | diagnostic images research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Dec2011
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=69627116&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 69627116 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: Dec2011 vid: 22 iid: 12 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 69627116 104611934 104611934 10.1111/j.1540-8167.2011.02128.x 69627116 ppf: 1309 ppct: 8 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Relationship Between Complex Fractionated Electrograms (CFE) and Dominant Frequency (DF) Sites and Prospective Assessment of Adding DF-Guided Ablation to Pulmonary Vein Isolation in Persistent Atrial Fibrillation (AF). aug: au: VERMA, ATUL LAKKIREDDY, DHANUNJAYA WULFFHART, ZAEV PILLARISETTI, JAYASREE FARINA, DOMENIC BEARDSALL, MARIANNE WHALEY, BONNIE GIEWERCER, DAVID TSANG, BERNICE KHAYKIN, YAARIV affil: Southlake Regional Health Centre, Newmarket, Ontario, Canada sug: subj: Atrial Fibrillation Surgery Pulmonary Veins Surgery Catheter Ablation Methods Heart Function Tests Methods Atrial Fibrillation Physiopathology Body Surface Potential Mapping Human Prospective Studies Descriptive Statistics Heart Conduction System Physiopathology Treatment Outcomes Male Female Middle Age Aged Unpaired T-Tests Chi Square Test Data Analysis Software Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Dominant Frequency Mapping and Ablation. Background: Sites of high DF are potential targets for AF ablation, but it is unknown if addition of DF ablation can improve procedural outcome. Objectives: We sought to (1) examine the relationship between DF sites and complex fractionated electrograms (CFE) and (2) prospectively assess the long-term outcome of adding DF ablation to pulmonary vein antral isolation (PVAI) for persistent AF. Methods: First, 20 patients with persistent AF who underwent previous CFE-guided ablation and who had AF terminate during ablation were studied retrospectively (group I). Bipolar, 8-second electrograms were collected by a circular catheter (288 ± 86 points/map). The EnSite NavX system allows for automated display of both CFE and DF maps. Electrograms with cycle length <120 ms were considered CFE and were compared to DF sites > 8 Hz (direct inverse relationship). Sites of AF termination were related to CFE and DF sites. Based on these observations, 30 different patients (group II) with persistent AF prospectively underwent DF-guided ablation plus PVAI. They were followed every 3 months for 1 year (visit, Holter, ECG). These patients were compared to case-matched controls undergoing PVAI alone (group III). Results: In group I, there was a significant, inverse correlation between DF and CFE values at each point (r =-0.24, P < 0.001). DF surface area was less than CFE area (27 ± 5 cm2 vs 34 ± 4 cm2, P = 0.03). CFE sites overlapped 48 ± 27% with the DF surface area. Nonoverlapping CFE sites were contiguous to DF sites. AF termination occurred where DF and CFE overlapped, and at these sites, DF was always greater than the mean DF for the map. In group II, all DF sites above the mean value were prospectively ablated during AF. AF termination was noted in only 2/30 (7%) patients. After DF ablation, PVAI was performed and termination increased to 4/30 patients (14%). At 1 year, freedom from atrial arrhythmia > 30 seconds occurred in 57% of DF+PVAI compared to 60% in patients receiving PVAI alone (P = 0.18). Conclusions: DF and CFE regions overlap only about 50%. AF termination retrospectively occurred on overlapping CFE/DF sites where DF was above the mean. However, prospective ablation of DF sites plus PVAI resulted in low AF termination rates, and did not improve 1 year success over PVAI alone. (J Cardiovasc Electrophysiol, Vol. 22, pp. 1309-1316, December 2011) pubtype: Academic Journal doctype: diagnostic images research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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