title: Real-time dominant frequency mapping and ablation of dominant frequency sites in atrial fibrillation with left-to-right frequency gradients predicts long-term maintenance of sinus rhythm.
abstract: BACKGROUND
  Spectral analysis identifies localized sites of high-frequency activity during atrial fibrillation (AF).
  
  
  OBJECTIVE
  This study sought to determine the effectiveness of using real-time dominant frequency (DF) mapping for radiofrequency ablation of maximal DF (DFmax) sites and elimination of left-to-right frequency gradients in the long-term maintenance of sinus rhythm (SR) in AF patients.
  
  
  METHODS
  DF mapping was performed in 50 patients during ongoing AF (32 paroxysmal, 18 persistent), acquiring a mean of 117 +/- 38 points. Ablation was performed targeting DFmax sites, followed by circumferential pulmonary vein isolation.
  
  
  RESULTS
  Ablation significantly reduced DFs (Hz) in the LA (7.9 +/- 1.4 vs. 5.7 +/- 1.3, P <.001), coronary sinus (CS) (5.7 +/- 1.1 vs. 5.3 +/- 1.2, P = .006), and RA (6.3 +/- 1.4 vs. 5.4 +/- 1.3, P <.001) abolishing baseline left-to-right atrial DF gradient (1.7 +/- 1.7 vs. 0.2 +/- 0.9; P <.001). Only a significant reduction in DFs in all chambers with a loss of the left-to-right atrial gradient after ablation was associated with a higher probability of long-term SR maintenance in both paroxysmal and persistent AF patients. After a mean follow-up of 9.3 +/- 5.4 months, 88% of paroxysmal and 56% of persistent AF patients were free of AF (P = .02). Ablation of DFmax sites was associated with a higher probability of remaining both free of arrhythmias (78% vs. 20%; P = .001) and free of AF (88% vs. 30%; P <.001).
  
  
  CONCLUSIONS
  Radiofrequency ablation leading to elimination of LA-to-RA frequency gradients predicts long-term SR maintenance in AF patients.
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Atienza
authors.forename: Jesús
authors.initials: J
authors.lastname: Almendral
authors.forename: José
authors.initials: J
authors.lastname: Jalife
authors.forename: Sharon
authors.initials: S
authors.lastname: Zlochiver
authors.forename: Robert
authors.initials: R
authors.lastname: Ploutz-Snyder
authors.forename: Esteban G
authors.initials: EG
authors.lastname: Torrecilla
authors.forename: Angel
authors.initials: A
authors.lastname: Arenal
authors.forename: Jérôme
authors.initials: J
authors.lastname: Kalifa
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
authors.forename: Omer
authors.initials: O
authors.lastname: Berenfeld
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery; D013614:Tachycardia, Paroxysmal / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors