Dennis H Lau1, Bart Maesen2, Stef Zeemering3, Pawel Kuklik1, Arne van Hunnik3, Theodorus A R Lankveld4, Elham Bidar2, Sander Verheule3, Jan Nijs5, Jos Maessen5, Harry Crijns6, Prashanthan Sanders7, Ulrich Schotten8. 1. Department of Physiology, Maastricht University, Maastricht,The Netherlands; Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia. 2. Department of Physiology, Maastricht University, Maastricht,The Netherlands; Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. 3. Department of Physiology, Maastricht University, Maastricht,The Netherlands. 4. Department of Physiology, Maastricht University, Maastricht,The Netherlands; Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands. 5. Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. 6. Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands. 7. Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia. 8. Department of Physiology, Maastricht University, Maastricht,The Netherlands. Electronic address: schotten@maastrichtuniversity.nl.
Abstract
BACKGROUND: The pathophysiological relevance of complex fractionated atrial electrograms (CFAE) in atrial fibrillation (AF) remains poorly understood. OBJECTIVE: The aim of this study was to comprehensively investigate how bipolar CFAE correlates with unipolar electrogram fractionation and the underlying electrophysiological substrate of AF. METHODS: Ten-second unipolar AF electrograms were recorded using a high-density electrode from the left atrium of 20 patients with AF (10 with persistent AF and 10 with paroxysmal AF) undergoing cardiac surgery. Semiautomated bipolar CFAE algorithms: complex fractionated electrogram-mean, interval confidence interval, continuous electrical activity, average complex interval, and shortest complex interval were evaluated against AF substrate complexity measures following fibrillation wave reconstruction derived from local unipolar activation time. The effect of interelectrode spacing and electrode orientation on bipolar CFAE was also examined. RESULTS: All 5 semiautomated bipolar CFAE algorithms showed poor correlation with each other and AF substrate complexity measures (conduction velocity, number of waves or breakthroughs per AF cycle, and electrical dissociation). Bipolar CFAE also correlated poorly with fractionation index derived from unipolar electrograms. Increased interelectrode spacing resulted in an increase in bipolar CFAE detected except for the interval confidence interval algorithm. CFAE appears unaffected by bipolar electrode orientation (vertical vs horizontal). By contrast, unipolar fractionation index correlated well with AF substrate complexity measures and can be regarded as a marker for conduction block. CONCLUSION: The lack of pathophysiological relevance of bipolar CFAE analysis may in part contribute to the divergent and limited success rates of catheter ablation strategies targeting CFAE.
BACKGROUND: The pathophysiological relevance of complex fractionated atrial electrograms (CFAE) in atrial fibrillation (AF) remains poorly understood. OBJECTIVE: The aim of this study was to comprehensively investigate how bipolar CFAE correlates with unipolar electrogram fractionation and the underlying electrophysiological substrate of AF. METHODS: Ten-second unipolar AF electrograms were recorded using a high-density electrode from the left atrium of 20 patients with AF (10 with persistent AF and 10 with paroxysmal AF) undergoing cardiac surgery. Semiautomated bipolar CFAE algorithms: complex fractionated electrogram-mean, interval confidence interval, continuous electrical activity, average complex interval, and shortest complex interval were evaluated against AF substrate complexity measures following fibrillation wave reconstruction derived from local unipolar activation time. The effect of interelectrode spacing and electrode orientation on bipolar CFAE was also examined. RESULTS: All 5 semiautomated bipolar CFAE algorithms showed poor correlation with each other and AF substrate complexity measures (conduction velocity, number of waves or breakthroughs per AF cycle, and electrical dissociation). Bipolar CFAE also correlated poorly with fractionation index derived from unipolar electrograms. Increased interelectrode spacing resulted in an increase in bipolar CFAE detected except for the interval confidence interval algorithm. CFAE appears unaffected by bipolar electrode orientation (vertical vs horizontal). By contrast, unipolar fractionation index correlated well with AF substrate complexity measures and can be regarded as a marker for conduction block. CONCLUSION: The lack of pathophysiological relevance of bipolar CFAE analysis may in part contribute to the divergent and limited success rates of catheter ablation strategies targeting CFAE.
Authors: Tiago P Almeida; Gavin S Chu; João L Salinet; Frederique J Vanheusden; Xin Li; Jiun H Tuan; Peter J Stafford; G André Ng; Fernando S Schlindwein Journal: Med Biol Eng Comput Date: 2016-02-25 Impact factor: 2.602
Authors: Pawel Kuklik; Benjamin Schäffer; Boris A Hoffmann; Anand N Ganesan; Doreen Schreiber; Julia M Moser; Ruken Ö Akbulak; Arian Sultan; Daniel Steven; Bart Maesen; Ulrich Schotten; Christian Meyer; Stephan Willems Journal: PLoS One Date: 2016-10-25 Impact factor: 3.240
Authors: Junaid A B Zaman; William H Sauer; Mahmood I Alhusseini; Tina Baykaner; Ryan T Borne; Christopher A B Kowalewski; Sonia Busch; Paul C Zei; Shirley Park; Mohan N Viswanathan; Paul J Wang; Johannes Brachmann; David E Krummen; John M Miller; Wouter Jan Rappel; Sanjiv M Narayan; Nicholas S Peters Journal: Circ Arrhythm Electrophysiol Date: 2018-01
Authors: Elton A M P Dudink; Elham Bidar; Judith Jacobs; Arne van Hunnik; Stef Zeemering; Bob Weijs; Justin G L M Luermans; Bart A E Maesen; Emile C Cheriex; Jos G Maessen; Jan C A Hoorntje; Ulrich Schotten; Harry J G M Crijns; Sander Verheule Journal: Int J Cardiol Heart Vasc Date: 2021-05-19