title: Novel assessment of temporal variation in fractionated electrograms using histogram analysis of local fractionation interval in patients with persistent atrial fibrillation.
abstract: BACKGROUND
  The characteristics of atrial electrograms associated with atrial fibrillation (AF) termination are controversial. We investigated the electrogram characteristics that indicate procedural AF termination during continuous complex fractionated electrogram ablation.
  
  
  RESULTS
  Fifty-two consecutive patients with persistent AF (47 men; aged 54 ± 9 years), who underwent electrogram-based catheter ablation in the left atrium and coronary sinus after pulmonary vein isolation, were enrolled. The intracardiac bipolar atrial electrogram recordings were characterized by (1) fractionation interval (FI) analysis (>6 seconds), (2) kurtosis (shape of the FI histogram), and (3) skewness (asymmetry of the FI histogram). Sites showing complex, fractionated electrograms (mean FI ≤ 60 ms) were targeted, and AF was terminated in 20 patients (38%) after the pulmonary vein isolation. The conventional complex fractionated electrogram sites (mean ≤ 120 ms) in patients with AF termination exhibited higher median kurtosis (2.69 [interquartile range, 2.03-3.46] versus 2.35 [interquartile range, 1.79-2.48]; P=0.024) and higher complex fractionated electrogram-mean interval (102.7 ± 19.8 versus 87.7 ± 15.0; P=0.008) than patients without AF termination. Furthermore, AF termination sites had higher median kurtosis than targeted sites without AF termination (5.13 [interquartile range, 3.51-6.47] versus 4.18 [interquartile range, 2.91-5.34]; P<0.01) in patients with procedural termination. In addition, patients with AF termination had a higher sinus rhythm maintenance rate after a single procedure than patients without AF termination (log-rank test, P=0.007).
  
  
  CONCLUSIONS
  A kurtosis analysis using the FI histogram may be a useful tool in identifying the critical substrate for persistent AF and potential responders to catheter ablation.
authors: Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Yenn-Jiang
authors: YJ
authors: Lin
authors: Kazuyoshi
authors: K
authors: Suenari
authors: Men-Tzung
authors: MT
authors: Lo
authors: Chen
authors: C
authors: Lin
authors: Wan-Hsin
authors: WH
authors: Hsieh
authors: Shih-Lin
authors: SL
authors: Chang
authors: Li-Wei
authors: LW
authors: Lo
authors: Yu-Feng
authors: YF
authors: Hu
authors: Chen-Chuan
authors: CC
authors: Cheng
authors: Yasuki
authors: Y
authors: Kihara
authors: Tze-Fan
authors: TF
authors: Chao
authors: Beny
authors: B
authors: Hartono
authors: Tsu-Juey
authors: TJ
authors: Wu
authors: Wei-Shiang
authors: WS
authors: Lin
authors: Ke-Hsin
authors: KH
authors: Hsu
authors: Ambrose S
authors: AS
authors: Kibos
authors: Norden E
authors: NE
authors: Huang
authors: Shih-Ann
authors: SA
authors: Chen
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation; D003627:Data Interpretation, Statistical; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome