title: Atrial fibrillatory rate in the clinical context: natural course and prediction of intervention outcome.
abstract: Shortening of atrial refractory period during atrial fibrillation has been considered a hallmark of atrial electrical remodelling. The atrial fibrillatory cycle length, which is intimately related to the atrial fibrillatory rate (AFR), is generally accepted as a surrogate marker for local refractoriness. The value of using AFR to monitor the progress of atrial ablation therapy has been demonstrated and gradual slowing of AFR has consistently been observed to precede arrhythmia termination during paroxysmal or permanent atrial fibrillation ablation. Today, AFR is the key characteristic of the fibrillatory process, repeatedly validated against intracardiac recordings and extensively studied in clinical contexts. This paper provides an overview of clinical data accumulated since the method was introduced in 1998, and to present the current state of knowledge regarding ECG-derived AFR: its time course and dynamics, clinical factors affecting AFR, and available evidence of its value in the clinical context. We conclude that AFR is a promising, easily available AF characteristic that can be derived from the conventional surface ECG. It is clearly a useful tool for monitoring drug effects. Reference values for predicting intervention effect, however, are likely to be population- and context-specific and related to age, clinical types of atrial fibrillation, as well as to presence and advancement of underlying structural heart disease. Prospective studies in homogeneous patient populations are still needed to establish the clinical value of AFR.
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund 22185, Sweden Center for Integrative Electrocardiology at Lund University (CIEL), Lund 22185, Sweden Pyotr.Platonov@med.lu.se.
authors.forename: Pyotr G
authors.initials: PG
authors.lastname: Platonov
authors.affiliation: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy.
authors.forename: Valentina D A
authors.initials: VD
authors.lastname: Corino
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund 22185, Sweden Center for Integrative Electrocardiology at Lund University (CIEL), Lund 22185, Sweden.
authors.forename: Mariam
authors.initials: M
authors.lastname: Seifert
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund 22185, Sweden Center for Integrative Electrocardiology at Lund University (CIEL), Lund 22185, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Holmqvist
authors.affiliation: Center for Integrative Electrocardiology at Lund University (CIEL), Lund 22185, Sweden Department of Biomedical Engineering, Lund University, Lund 22185, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Sörnmo
mesh_terms: D000200:Action Potentials; D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D064752:Atrial Remodeling; D017115:Catheter Ablation; D004554:Electric Countershock; D004562:Electrocardiography; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008955:Models, Cardiovascular; D011237:Predictive Value of Tests; D012032:Refractory Period, Electrophysiological; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Atrial; Atrial fibrillation