Focal impulse and rotor modulation of atrial rotors during atrial fibrillation leads to organization of left atrial activation as reflected by waveform morphology recurrence quantification analysis and organizational index
Abstract Background Focal impulse and rotor modulation (FIRM) can cause slowing, organization, and occasionally termination of atrial fibrillation (AF), although results have been mixed. To further characterize changes in AF during rotor ablation, we quantified morphologic and temporal activation ch...
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doaj-25600a255f4c47b9b851730b2261e4ea2020-11-25T02:28:40ZengWileyJournal of Arrhythmia1880-42761883-21482020-04-0136231131810.1002/joa3.12311Focal impulse and rotor modulation of atrial rotors during atrial fibrillation leads to organization of left atrial activation as reflected by waveform morphology recurrence quantification analysis and organizational indexPeter R. Liu0Daniel J. Friedman1Adam S. Barnett2Kevin P. Jackson3James P. Daubert4Jonathan P. Piccini5Department of Medicine Johns Hopkins Hospital Baltimore MD USADuke Center for Atrial Fibrillation Duke Clinical Research Institute Duke University Medical Center Durham NC USADuke Center for Atrial Fibrillation Duke Clinical Research Institute Duke University Medical Center Durham NC USADuke Center for Atrial Fibrillation Duke Clinical Research Institute Duke University Medical Center Durham NC USADuke Center for Atrial Fibrillation Duke Clinical Research Institute Duke University Medical Center Durham NC USADuke Center for Atrial Fibrillation Duke Clinical Research Institute Duke University Medical Center Durham NC USAAbstract Background Focal impulse and rotor modulation (FIRM) can cause slowing, organization, and occasionally termination of atrial fibrillation (AF), although results have been mixed. To further characterize changes in AF during rotor ablation, we quantified morphologic and temporal activation changes following FIRM. Methods In patients undergoing FIRM ablation for AF, we retrospectively analyzed coronary sinus bipolar EGMs before and after rotor ablation, including EGM activation frequency and regularity, dominant frequency (DF), and organizational index (OI). Changes in EGM waveform morphology were determined with recurrence quantification analysis (RQA) consisting of recurrence rate (RR), determinism (DET), laminarity (LAM), average diagonal line length (L), and trapping time (TT) using Wilcoxon signed‐rank testing. Results Overall, 36 rotors from 21 patients undergoing FIRM ablation were analyzed. All morphology RQA parameters demonstrated significant organization of atrial activation after rotor ablation (RR P = .03, DET P = .005, LAM P = .03, L P = .005, TT P = .009). The organizational index also showed a significant increase after rotor ablation (P = .01), and the change in OI correlated with changes in all morphology parameters. Of the rotors, 14/36 (39%) rotors showed organizational changes in all morphology parameters and OI, and an additional 5 rotors (19/36, 53%) showed organizational changes in 4 of 5 morphology parameters and OI. Conclusions Coronary sinus EGM waveform morphologies and activation patterns are significantly altered after FIRM ablation even when there is no fibrillatory slowing. RQA morphology analysis and organizational index may impart important information regarding underlying AF organization and may be useful in quantifying the acute response to ablation.https://doi.org/10.1002/joa3.12311atrial fibrillationcardiac mappingcatheter ablationelectrogram analysisrotor ablation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Peter R. Liu Daniel J. Friedman Adam S. Barnett Kevin P. Jackson James P. Daubert Jonathan P. Piccini |
spellingShingle |
Peter R. Liu Daniel J. Friedman Adam S. Barnett Kevin P. Jackson James P. Daubert Jonathan P. Piccini Focal impulse and rotor modulation of atrial rotors during atrial fibrillation leads to organization of left atrial activation as reflected by waveform morphology recurrence quantification analysis and organizational index Journal of Arrhythmia atrial fibrillation cardiac mapping catheter ablation electrogram analysis rotor ablation |
author_facet |
Peter R. Liu Daniel J. Friedman Adam S. Barnett Kevin P. Jackson James P. Daubert Jonathan P. Piccini |
author_sort |
Peter R. Liu |
title |
Focal impulse and rotor modulation of atrial rotors during atrial fibrillation leads to organization of left atrial activation as reflected by waveform morphology recurrence quantification analysis and organizational index |
title_short |
Focal impulse and rotor modulation of atrial rotors during atrial fibrillation leads to organization of left atrial activation as reflected by waveform morphology recurrence quantification analysis and organizational index |
title_full |
Focal impulse and rotor modulation of atrial rotors during atrial fibrillation leads to organization of left atrial activation as reflected by waveform morphology recurrence quantification analysis and organizational index |
title_fullStr |
Focal impulse and rotor modulation of atrial rotors during atrial fibrillation leads to organization of left atrial activation as reflected by waveform morphology recurrence quantification analysis and organizational index |
title_full_unstemmed |
Focal impulse and rotor modulation of atrial rotors during atrial fibrillation leads to organization of left atrial activation as reflected by waveform morphology recurrence quantification analysis and organizational index |
title_sort |
focal impulse and rotor modulation of atrial rotors during atrial fibrillation leads to organization of left atrial activation as reflected by waveform morphology recurrence quantification analysis and organizational index |
publisher |
Wiley |
series |
Journal of Arrhythmia |
issn |
1880-4276 1883-2148 |
publishDate |
2020-04-01 |
description |
Abstract Background Focal impulse and rotor modulation (FIRM) can cause slowing, organization, and occasionally termination of atrial fibrillation (AF), although results have been mixed. To further characterize changes in AF during rotor ablation, we quantified morphologic and temporal activation changes following FIRM. Methods In patients undergoing FIRM ablation for AF, we retrospectively analyzed coronary sinus bipolar EGMs before and after rotor ablation, including EGM activation frequency and regularity, dominant frequency (DF), and organizational index (OI). Changes in EGM waveform morphology were determined with recurrence quantification analysis (RQA) consisting of recurrence rate (RR), determinism (DET), laminarity (LAM), average diagonal line length (L), and trapping time (TT) using Wilcoxon signed‐rank testing. Results Overall, 36 rotors from 21 patients undergoing FIRM ablation were analyzed. All morphology RQA parameters demonstrated significant organization of atrial activation after rotor ablation (RR P = .03, DET P = .005, LAM P = .03, L P = .005, TT P = .009). The organizational index also showed a significant increase after rotor ablation (P = .01), and the change in OI correlated with changes in all morphology parameters. Of the rotors, 14/36 (39%) rotors showed organizational changes in all morphology parameters and OI, and an additional 5 rotors (19/36, 53%) showed organizational changes in 4 of 5 morphology parameters and OI. Conclusions Coronary sinus EGM waveform morphologies and activation patterns are significantly altered after FIRM ablation even when there is no fibrillatory slowing. RQA morphology analysis and organizational index may impart important information regarding underlying AF organization and may be useful in quantifying the acute response to ablation. |
topic |
atrial fibrillation cardiac mapping catheter ablation electrogram analysis rotor ablation |
url |
https://doi.org/10.1002/joa3.12311 |
work_keys_str_mv |
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