Spatiotemporal characterization of atrial activation in persistent human atrial fibrillation: Multisite electrogram analysis and surface electrocardiographic correlations—A pilot study

Background The mechanisms of persistent human atrial fibrillation (AF) are not well understood. Objective The purpose of this study was to examine whether left atrial (LA) drivers are present in persistent AF by performing a comprehensive evaluation of atrial activation frequency and organization using multisite atrial recordings and correlating the findings with atrial waveform frequency and organization on surface ECG. Methods Nine patients undergoing catheter ablation for persistent AF were studied. Electrograms were recorded from at least 10 sites in each atrium, tagged to an electroanatomic map, and subjected to spectral analysis. Dominant frequency (DF) and regularity index were calculated at each site. Surface ECG recordings were analyzed to obtain precordial lead DFs and AF vector stability index. Results Mean, maximum, and minimum DF and mean regularity index were higher in LA than right atrium (RA). DF was correlated with regularity index (R = 0.59, P