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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Effects of Two Different Catheter Ablation Techniques on Spectral Characteristics of Atrial Fibrillation

Kristina Lemola, MD^,1, Michael Ting, MS_^*, Priya Gupta, MS_^*, Jeffrey N. Anker, PhD, Aman Chugh, MD, Eric Good, DO, Scott Reich, MD, David Tschopp, MD, Petar Igic, MD, Darryl Elmouchi, MD, Krit Jongnarangsin, MD, Frank Bogun, MD, Frank Pelosi, Jr, MD, Fred Morady, MD^,2 and Hakan Oral, MD^,2,_*

^_* Department of Electrical Engineering & Computer Science, University of Michigan, Ann Arbor, Michigan
LSA Chemistry and Applied Physics, University of Michigan, Ann Arbor, Michigan
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.

Manuscript received January 26, 2006; revised manuscript received March 23, 2006, accepted April 4, 2006.

^_* Reprint requests and correspondence: Dr. Hakan Oral, Cardiology, TC B1 140D, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0311. (Email: oralh{at}umich.edu).

OBJECTIVES: The aim of this study was to determine the effects of circumferential pulmonary vein ablation (CPVA) and electrogram-guided ablation (EGA) on the spectral characteristics of atrial fibrillation (AF) and the relationship between changes in dominant frequency (DF) and clinical outcome.

BACKGROUND: Circumferential pulmonary vein ablation and EGA have been used to eliminate AF. Spectral analysis may identify high-frequency sources.

METHODS: In 84 consecutive patients, CPVA (n = 42) or EGA (n = 42) was performed for paroxysmal (n = 49) or persistent (n = 35) AF. During EGA, complex electrograms were targeted. Lead V₁ and electrograms from the left atrium and coronary sinus were analyzed to determine the DF of AF before and after ablation.

RESULTS: The left atrial DF was higher in persistent (5.83 ± 0.86 Hz) than paroxysmal AF (5.33 ± 0.76 Hz, p = 0.03). There was a frequency gradient from the left atrium to the coronary sinus (p = 0.02). Circumferential pulmonary vein ablation and EGA resulted in a similar decrease in DF (18 ± 17% vs. 17 ± 15%, p = 0.8). During a mean follow-up of 9 ± 6 months, the change in DF after CPVA was similar among patients with and without recurrent AF. An acute decrease in DF after EGA was associated with freedom from recurrent AF only in patients with persistent AF (19 ± 14% vs. 3 ± 6%, p = 0.02).

CONCLUSIONS: Both CPVA and EGA decrease the DF of AF, consistent with elimination of high-frequency sources. Whereas the efficacy of EGA is associated with a decrease in DF in patients with persistent AF, the efficacy of CPVA is independent of changes in DF. This suggests that CPVA and EGA eliminate different mechanisms in the genesis of persistent AF.

Abbreviations and Acronyms   AF = atrial fibrillation   CPVA = circumferential pulmonary vein ablation   DF = dominant frequency   EGA = electrogram-guided ablation   FFT = fast Fourier transformation

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