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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Characterization of Electrograms Associated With Termination of Chronic Atrial Fibrillation by Catheter Ablation

Yoshihide Takahashi, MD^_*,_*, Mark D. O’Neill, MB, BCh, DPhil^_*, Mélèze Hocini, MD^_*, Rémi Dubois, PhD, Seiichiro Matsuo, MD^_*, Sébastien Knecht, MD^_*, Srijoy Mahapatra, MD^_*, Kang-Teng Lim, MD^_*, Pierre Jaïs, MD^_*, Anders Jonsson, MD^_*, Frédéric Sacher, MD^_*, Prashanthan Sanders, MBBS, PhD^_*, Thomas Rostock, MD^_*, Pierre Bordachar, MD^_*, Jacques Clémenty, MD^_*, George J. Klein, MD^_* and Michel Haïssaguerre, MD^_*

^_* Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux 2, Bordeaux, France
Laboratoire d’Electronique, ESPCI, Paris, France.

Manuscript received August 2, 2007; revised manuscript received September 21, 2007, accepted October 22, 2007.

^_* Reprint requests and correspondence: Dr. Yoshihide Takahashi, Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France. (Email: yoshihide_takahashi{at}oboe.ocn.ne.jp).

Objectives: This study sought to determine the characteristics of atrial electrograms predictive of slowing or termination of atrial fibrillation (AF) during ablation of chronic AF.

Background: There is growing recognition of a role for electrogram-based ablation.

Methods: Forty consecutive patients (34 male, 59 ± 10 years) undergoing ablation for chronic AF persisting for a median of 12 months (range 1 to 84 months) were included. After pulmonary vein isolation and roof line ablation, electrogram-based ablation was performed in the left atrium and coronary sinus. Targeted electrograms were acquired in a 4-s window and characterized by: 1) percentage of continuous electrical activity; 2) bipolar voltage; 3) dominant frequency; 4) fractionation index; 5) mean absolute value of derivatives of electrograms; 6) local cycle length; and 7) presence of a temporal gradient of activation. Electrogram characteristics at favorable ablation regions, defined as those associated with slowing (a 6-ms increase in AF cycle length) or termination of AF were compared with those at unfavorable regions.

Results: The AF was terminated by electrogram-based ablation in 29 patients (73%) after targeting a total of 171 regions. Ablation at 37 (22%) of these regions was followed by AF slowing, and at 29 (17%) by AF termination. The percentage of continuous electrical activity and the presence of a temporal gradient of activation were independent predictors of favorable ablation regions (p = 0.016 and p = 0.038, respectively). Other electrogram characteristics at favorable ablation regions were not significantly different from those at unfavorable ablation regions.

Conclusions: Catheter ablation at sites displaying a greater percentage of continuous activity or a temporal activation gradient is associated with slowing or termination of chronic AF.

Abbreviations and Acronyms   AF = atrial fibrillation   CL = cycle length   CS = coronary sinus   DF = dominant frequency   LA = left atrium   LAA = left atrial appendage   PV = pulmonary vein   RF = radiofrequency

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