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
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 r...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2008-10, Vol.19 (10), p.1017-1023 |
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| creator | YOSHIDA, KENTARO ULFARSSON, MAGNUS TADA, HIROSHI CHUGH, AMAN GOOD, ERIC KUHNE, MICHAEL CRAWFORD, THOMAS SARRAZIN, JEAN F. CHALFOUN, NAGIB WELLS, DARRYL JONGNARANGSIN, KRIT PELOSI JR, FRANK BOGUN, FRANK MORADY, FRED ORAL, HAKAN |
| description | 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 among patients 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. |
| doi_str_mv | 10.1111/j.1540-8167.2008.01175.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69638418</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69638418</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4555-88ee428e177c8ee202c57a087a6f33cccaa1f0927a2e76d4e5add2f5d582b19b3</originalsourceid><addsrcrecordid>eNqNkcFy0zAQhj0MDC2FV2B04lQHybZshRkOwSSlTGkDBMpNo8hromBbQZKnyTPzEqzrTLmii3al__ul2T-KCKMThuv1dsJ4RmPB8mKSUComlLGCT_aPotOHi8dY04zHqSjSk-iZ91tKWZpT_jQ6YSLLkzTNTqM_pW13DezJvAEdnP3pVOvJrQkb05GwAVJaZzvlDuSr6Xr_hqxMCzFRXUUWDn730OlD_N62CuXlRjmlAzjjg9H-nMzrGk09sTWZdcGphiz7ph3tvgMSl942Khjbnd87foGx8xuzI8GSsjGd0Yjd9EHbFggiS1RAh6Z3-EfsnN0ffIuawWAJzuPjeE9mwRk8XZi1M81o-zx6UqvGw4vjfhZ9W8xX5Yf46ubispxdxTrjnMdCAGSJAFYUGsuEJpoXiopC5XWaaq2VYjWdJoVKoMirDLiqqqTmFRfJmk3X6Vn0avTdOYsT8kG2xmvAX3Rgey_zaZ6KjAkUilGonfXeQS13zrQ4HcmoHIKWWznkKYc85RC0vA9a7hF9eXyjX7dQ_QOPyaLg7Si4Mw0c_ttYfiznQ4V8PPLDPPcPvHK_ZF6kKL29vpA_aLa6_vT5nRTpX0NXzE4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>69638418</pqid></control><display><type>article</type><title>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</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>YOSHIDA, KENTARO ; ULFARSSON, MAGNUS ; TADA, HIROSHI ; CHUGH, AMAN ; GOOD, ERIC ; KUHNE, MICHAEL ; CRAWFORD, THOMAS ; SARRAZIN, JEAN F. ; CHALFOUN, NAGIB ; WELLS, DARRYL ; JONGNARANGSIN, KRIT ; PELOSI JR, FRANK ; BOGUN, FRANK ; MORADY, FRED ; ORAL, HAKAN</creator><creatorcontrib>YOSHIDA, KENTARO ; ULFARSSON, MAGNUS ; TADA, HIROSHI ; CHUGH, AMAN ; GOOD, ERIC ; KUHNE, MICHAEL ; CRAWFORD, THOMAS ; SARRAZIN, JEAN F. ; CHALFOUN, NAGIB ; WELLS, DARRYL ; JONGNARANGSIN, KRIT ; PELOSI JR, FRANK ; BOGUN, FRANK ; MORADY, FRED ; ORAL, HAKAN</creatorcontrib><description>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 among patients 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.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/j.1540-8167.2008.01175.x</identifier><identifier>PMID: 18462334</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>atrial fibrillation ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - surgery ; Body Surface Potential Mapping ; catheter ablation ; Chronic Disease ; Coronary Sinus ; Female ; frequency-domain analysis ; Heart Conduction System - surgery ; Humans ; Male ; Middle Aged ; Outcome Assessment (Health Care) - methods ; Pulmonary Veins - surgery ; time-domain analysis ; Treatment Outcome</subject><ispartof>Journal of cardiovascular electrophysiology, 2008-10, Vol.19 (10), p.1017-1023</ispartof><rights>2008 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4555-88ee428e177c8ee202c57a087a6f33cccaa1f0927a2e76d4e5add2f5d582b19b3</citedby><cites>FETCH-LOGICAL-c4555-88ee428e177c8ee202c57a087a6f33cccaa1f0927a2e76d4e5add2f5d582b19b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1540-8167.2008.01175.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1540-8167.2008.01175.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18462334$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>YOSHIDA, KENTARO</creatorcontrib><creatorcontrib>ULFARSSON, MAGNUS</creatorcontrib><creatorcontrib>TADA, HIROSHI</creatorcontrib><creatorcontrib>CHUGH, AMAN</creatorcontrib><creatorcontrib>GOOD, ERIC</creatorcontrib><creatorcontrib>KUHNE, MICHAEL</creatorcontrib><creatorcontrib>CRAWFORD, THOMAS</creatorcontrib><creatorcontrib>SARRAZIN, JEAN F.</creatorcontrib><creatorcontrib>CHALFOUN, NAGIB</creatorcontrib><creatorcontrib>WELLS, DARRYL</creatorcontrib><creatorcontrib>JONGNARANGSIN, KRIT</creatorcontrib><creatorcontrib>PELOSI JR, FRANK</creatorcontrib><creatorcontrib>BOGUN, FRANK</creatorcontrib><creatorcontrib>MORADY, FRED</creatorcontrib><creatorcontrib>ORAL, HAKAN</creatorcontrib><title>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</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>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 among patients 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.</description><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - surgery</subject><subject>Body Surface Potential Mapping</subject><subject>catheter ablation</subject><subject>Chronic Disease</subject><subject>Coronary Sinus</subject><subject>Female</subject><subject>frequency-domain analysis</subject><subject>Heart Conduction System - surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Outcome Assessment (Health Care) - methods</subject><subject>Pulmonary Veins - surgery</subject><subject>time-domain analysis</subject><subject>Treatment Outcome</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkcFy0zAQhj0MDC2FV2B04lQHybZshRkOwSSlTGkDBMpNo8hromBbQZKnyTPzEqzrTLmii3al__ul2T-KCKMThuv1dsJ4RmPB8mKSUComlLGCT_aPotOHi8dY04zHqSjSk-iZ91tKWZpT_jQ6YSLLkzTNTqM_pW13DezJvAEdnP3pVOvJrQkb05GwAVJaZzvlDuSr6Xr_hqxMCzFRXUUWDn730OlD_N62CuXlRjmlAzjjg9H-nMzrGk09sTWZdcGphiz7ph3tvgMSl942Khjbnd87foGx8xuzI8GSsjGd0Yjd9EHbFggiS1RAh6Z3-EfsnN0ffIuawWAJzuPjeE9mwRk8XZi1M81o-zx6UqvGw4vjfhZ9W8xX5Yf46ubispxdxTrjnMdCAGSJAFYUGsuEJpoXiopC5XWaaq2VYjWdJoVKoMirDLiqqqTmFRfJmk3X6Vn0avTdOYsT8kG2xmvAX3Rgey_zaZ6KjAkUilGonfXeQS13zrQ4HcmoHIKWWznkKYc85RC0vA9a7hF9eXyjX7dQ_QOPyaLg7Si4Mw0c_ttYfiznQ4V8PPLDPPcPvHK_ZF6kKL29vpA_aLa6_vT5nRTpX0NXzE4</recordid><startdate>200810</startdate><enddate>200810</enddate><creator>YOSHIDA, KENTARO</creator><creator>ULFARSSON, MAGNUS</creator><creator>TADA, HIROSHI</creator><creator>CHUGH, AMAN</creator><creator>GOOD, ERIC</creator><creator>KUHNE, MICHAEL</creator><creator>CRAWFORD, THOMAS</creator><creator>SARRAZIN, JEAN F.</creator><creator>CHALFOUN, NAGIB</creator><creator>WELLS, DARRYL</creator><creator>JONGNARANGSIN, KRIT</creator><creator>PELOSI JR, FRANK</creator><creator>BOGUN, FRANK</creator><creator>MORADY, FRED</creator><creator>ORAL, HAKAN</creator><general>Blackwell Publishing Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200810</creationdate><title>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</title><author>YOSHIDA, KENTARO ; ULFARSSON, MAGNUS ; TADA, HIROSHI ; CHUGH, AMAN ; GOOD, ERIC ; KUHNE, MICHAEL ; CRAWFORD, THOMAS ; SARRAZIN, JEAN F. ; CHALFOUN, NAGIB ; WELLS, DARRYL ; JONGNARANGSIN, KRIT ; PELOSI JR, FRANK ; BOGUN, FRANK ; MORADY, FRED ; ORAL, HAKAN</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4555-88ee428e177c8ee202c57a087a6f33cccaa1f0927a2e76d4e5add2f5d582b19b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - surgery</topic><topic>Body Surface Potential Mapping</topic><topic>catheter ablation</topic><topic>Chronic Disease</topic><topic>Coronary Sinus</topic><topic>Female</topic><topic>frequency-domain analysis</topic><topic>Heart Conduction System - surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Outcome Assessment (Health Care) - methods</topic><topic>Pulmonary Veins - surgery</topic><topic>time-domain analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>YOSHIDA, KENTARO</creatorcontrib><creatorcontrib>ULFARSSON, MAGNUS</creatorcontrib><creatorcontrib>TADA, HIROSHI</creatorcontrib><creatorcontrib>CHUGH, AMAN</creatorcontrib><creatorcontrib>GOOD, ERIC</creatorcontrib><creatorcontrib>KUHNE, MICHAEL</creatorcontrib><creatorcontrib>CRAWFORD, THOMAS</creatorcontrib><creatorcontrib>SARRAZIN, JEAN F.</creatorcontrib><creatorcontrib>CHALFOUN, NAGIB</creatorcontrib><creatorcontrib>WELLS, DARRYL</creatorcontrib><creatorcontrib>JONGNARANGSIN, KRIT</creatorcontrib><creatorcontrib>PELOSI JR, FRANK</creatorcontrib><creatorcontrib>BOGUN, FRANK</creatorcontrib><creatorcontrib>MORADY, FRED</creatorcontrib><creatorcontrib>ORAL, HAKAN</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>YOSHIDA, KENTARO</au><au>ULFARSSON, MAGNUS</au><au>TADA, HIROSHI</au><au>CHUGH, AMAN</au><au>GOOD, ERIC</au><au>KUHNE, MICHAEL</au><au>CRAWFORD, THOMAS</au><au>SARRAZIN, JEAN F.</au><au>CHALFOUN, NAGIB</au><au>WELLS, DARRYL</au><au>JONGNARANGSIN, KRIT</au><au>PELOSI JR, FRANK</au><au>BOGUN, FRANK</au><au>MORADY, FRED</au><au>ORAL, HAKAN</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2008-10</date><risdate>2008</risdate><volume>19</volume><issue>10</issue><spage>1017</spage><epage>1023</epage><pages>1017-1023</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>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 among patients 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.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>18462334</pmid><doi>10.1111/j.1540-8167.2008.01175.x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | atrial fibrillation Atrial Fibrillation - diagnosis Atrial Fibrillation - surgery Body Surface Potential Mapping catheter ablation Chronic Disease Coronary Sinus Female frequency-domain analysis Heart Conduction System - surgery Humans Male Middle Aged Outcome Assessment (Health Care) - methods Pulmonary Veins - surgery time-domain analysis Treatment Outcome |
| title | 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 |
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