Effects of two different catheter ablation techniques on spectral characteristics of atrial fibrillation.
OBJECTIVE
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.
Lemola
Kristina
K
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Ting
Michael
M
Gupta
Priya
P
Anker
Jeffrey N
JN
Chugh
Aman
A
Good
Eric
E
Reich
Scott
S
Tschopp
David
D
Igic
Petar
P
Elmouchi
Darryl
D
Jongnarangsin
Krit
K
Bogun
Frank
F
Pelosi
Frank
F
Morady
Fred
F
Oral
Hakan
H
D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D012815:Signal Processing, Computer-Assisted; D017550:Spectroscopy, Fourier Transform Infrared