AUTHOR=Rodrigo Miguel , Waddell Kian , Magee Sarah , Rogers Albert J. , Alhusseini Mahmood , Hernandez-Romero Ismael , Costoya-Sánchez Alejandro , Liberos Alejandro , Narayan Sanjiv M.
TITLE=Non-invasive Spatial Mapping of Frequencies in Atrial Fibrillation: Correlation With Contact Mapping
JOURNAL=Frontiers in Physiology
VOLUME=11
YEAR=2021
URL=https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2020.611266
DOI=10.3389/fphys.2020.611266
ISSN=1664-042X
ABSTRACT=Introduction: Regional differences in activation rates may contribute to the electrical substrates that maintain atrial fibrillation (AF), and estimating them non-invasively may help guide ablation or select anti-arrhythmic medications. We tested whether non-invasive assessment of regional AF rate accurately represents intracardiac recordings.
Methods: In 47 patients with AF (27 persistent, age 63 ± 13 years) we performed 57-lead non-invasive Electrocardiographic Imaging (ECGI) in AF, simultaneously with 64-pole intracardiac signals of both atria. ECGI was reconstructed by Tikhonov regularization. We constructed personalized 3D AF rate distribution maps by Dominant Frequency (DF) analysis from intracardiac and non-invasive recordings.
Results: Raw intracardiac and non-invasive DF differed substantially, by 0.54 Hz [0.13 – 1.37] across bi-atrial regions (R2 = 0.11). Filtering by high spectral organization reduced this difference to 0.10 Hz (cycle length difference of 1 – 11 ms) [0.03 – 0.42] for patient-level comparisons (R2 = 0.62), and 0.19 Hz [0.03 – 0.59] and 0.20 Hz [0.04 – 0.61] for median and highest DF, respectively. Non-invasive and highest DF predicted acute ablation success (p = 0.04).
Conclusion: Non-invasive estimation of atrial activation rates is feasible and, when filtered by high spectral organization, provide a moderate estimate of intracardiac recording rates in AF. Non-invasive technology could be an effective tool to identify patients who may respond to AF ablation for personalized therapy.