Spectral analysis during sinus rhythm predicts an abnormal atrial substrate in patients with paroxysmal atrial fibrillation.
BACKGROUND
Regions of rapid and multiple deflections can be identified with high dominant frequency (DF) during sinus rhythm (SR). These areas may play a role in the perpetuation of atrial fibrillation (AF) and indicate an atrial substrate abnormality.


OBJECTIVE
The purpose of this study was to investigate the atrial substrate properties of the high-frequency sites in patients with paroxysmal AF.


METHODS
Forty patients (52 +/- 12 years of age) with paroxysmal AF were studied using a three-dimensional mapping system. Spectral analysis was performed on the bipolar electrograms in the left atrium (LA) during SR. Overall, 7708 electrograms were analyzed, and the DFs higher than 70 Hz were labeled as abnormal.


RESULTS
The regional distribution of the high-DF sites in the LA could be divided into two types. Type 1 includes high-DF sites existing only in the pulmonary veins (PVs; n = 19, 6.6 +/- 3.4 sites/patient). Type 2 includes high-DF sites in the LA or LA plus the PVs (n = 21, 11 +/- 5.6 sites/patient). In type 1, PV isolation (PVI) could eliminate the AF with negative AF inducibility testing after the PVI in 89% of patients. In type 2, additional LA substrate modification was needed in 81% of patients because sustained AF was induced after the PVI (P<.001, compared with type 1). Multivariate analysis showed that the lower mean voltage of the LA and high-frequency sites distribution both independently predicted a positive AF inducibility after the PVI (P<.05).


CONCLUSIONS
Spectral analysis during SR can detect an abnormal atrial substrate. A regional distribution of the high-DF sites predicts the efficacy of the PVI.
Lin
Yenn-Jiang
YJ
Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Kao
Tsair
T
Tai
Ching-Tai
CT
Chang
Shih-Lin
SL
Lo
Li-Wei
LW
Tuan
Ta-Chuan
TC
Udyavar
Ameya R
AR
Hu
Yu-Feng
YF
Tso
Han-Wen
HW
Higa
Satoshi
S
Chen
Shih-Ann
SA
D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged