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Lookup NU author(s): Dr Luigi Di Marco, Dr Daniel Raine, Dr John Bourke, Dr Philip Langley
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BACKGROUND Successful termination of atrial fibrillation (AF) during catheter ablation (CA) is associated with arrhythmia-free follow-up. Preablation factors such as mean atrial fibrillation cycle length (AFCL) predict the likelihood of AF termination during ablation but recurring patterns and AFCL stability have not been evaluated. OBJECTIVE To investigate novel predictors of acute and postoperative ablation outcomes from intracardiac electrograms: (1) recurring AFCL patterns and (2) localization index (LI) of the instantaneous fibrillatory rate distribution. METHODS Sixty-two patients with AF (32 paroxysmal AF; 45 men; age 57 +/- 10 years) referred for CA were enrolled. One-minute electrogram was recorded from coronary sinus (CS; 5 bipoles) and right atrial appendage (HRA; 2 bipoles). Atrial activations were detected automatically to derive the AFCL and instantaneous fibrillatory rate (inverse of AFCL) time series. Recurring AFCL patterns were quantified by using recurrence plot indices (RPIs): percentage determinism, entropy of determinism, and maximum diagonal length. AFCL stability was determined by using the LI. The CA outcome predictivity of individual indices was assessed. RESULTS Patients with terminated atrial fibrillation (T-AF) had higher RPI (P < .05 in CS7-8) and LI than did those with nonterminated atrial fibrillation (P < .005 in CS3-4; P < .05 in CS5-6, CS7-8, and HRA). Patients free of arrhythmia after 3-month follow-up had higher RPI and LI (all P < .05 in CS7-8). All indices except percentage determinism predicted T-AF in CS7-8 (area under the curve [AUC] >= 0.71; odds ratio [OR] >= 4.50; P < .05). The median AFCL and LI predicted T-AF in HRA(D) (AUC >= 0.75; OR >= 7.76; P < .05). The RPI and LI predicted 3-month follow-up in CS7-8 (AUC >= 0.68; OR >= 4.17; P < .05). CONCLUSIONS AFCL recurrence and stability indices could be used in selecting patients more likely to benefit from CA.
Author(s): Di Marco LY, Raine D, Bourke JP, Langley P
Publication type: Article
Publication status: Published
Journal: Heart Rhythm
Year: 2013
Volume: 10
Issue: 9
Pages: 1303-1310
Print publication date: 13/06/2013
ISSN (print): 1547-5271
ISSN (electronic): 1556-3871
Publisher: Elsevier
URL: http://dx.doi.org/10.1016/j.hrthm.2013.06.007
DOI: 10.1016/j.hrthm.2013.06.007
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