title: Histogram analysis: a novel method to detect and differentiate fractionated electrograms during atrial fibrillation.
abstract: BACKGROUND
  Complex fractionated atrial electrograms (CFAEs) might identify the critical substrate maintaining AF. We developed a method based upon histogram analysis of interpeak intervals (IPIs) to automatically quantify fractionation and differentiate between subtypes of CFAEs.
  
  
  METHODS
  Two experts classified 1,681 fibrillatory electrograms recorded in 13 patients with persistent AF into 3 categories (gold standard): normal electrograms, discontinuous CFAEs, or continuous CFAEs. Histogram analysis of IPI was performed to calculate the P5, P50, P95, and the mean of IPIs, in addition to the total number of IPI (N(Total)), and the number of IPI within predetermined ranges: 10-60 (N(Short)), 60-120 (N(Intermediate)), and >120 ms (N(Long)).
  
  
  RESULTS
  P50 and N(Long) were higher in the normal electrograms compared to the other 2 categories (P < 0.001). N(Intermediate) was higher in the discontinuous CFAE category compared to the other 2 categories. P95, mean IPI, N(Total), and N(Short) were all significantly different among the 3 categories (P < 0.001) and correlated with the degree of fractionation (r =-0.52, -0.55, 0.68, and 0.67, respectively). Receiver operating characteristic (ROC) curves showed good diagnostic accuracy (area under curve, AUC > 0.8) of P50 and N(Long) to detect normal electrograms. An algorithm using N(Intermediate) showed good diagnostic accuracy (AUC > 0.7) to detect discontinuous CFAEs, whereas P95, mean, N(Total), and N(Short) all revealed high diagnostic accuracy (AUC > 0.85) to detect continuous CFAEs. This was confirmed in a prospective data set.
  
  
  CONCLUSIONS
  Histogram analysis of IPI can differentiate between normal electrograms, discontinuous and continuous fractionated electrograms. This method might be used to standardize and optimize ablation strategies in AF.
authors.affiliation: Department of Internal Medicine, Ghent University, Ghent, Belgium. milad.elhaddad@ugent.be
authors.forename: Milad
authors.initials: M
authors.lastname: El Haddad
authors.forename: Richard
authors.initials: R
authors.lastname: Houben
authors.forename: Tom
authors.initials: T
authors.lastname: Claessens
authors.forename: Rene
authors.initials: R
authors.lastname: Tavernier
authors.forename: Roland
authors.initials: R
authors.lastname: Stroobandt
authors.forename: Mattias
authors.initials: M
authors.lastname: Duytschaever
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D017115:Catheter Ablation / Q000379:methods / Q000592:standards; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods* / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results