title: Atrial electrogram discordance during baseline vs reinduced atrial fibrillation: Potential ramifications for ablation procedures.
abstract: BACKGROUND
  There are scant data comparing the electrogram (EGM) signal characteristics of atrial fibrillation (AF) at baseline vs electrically induced states during ablation procedures.
  
  
  OBJECTIVE
  The purpose of this study was to use novel intracardiac signal analysis techniques to gain insights into the effects of catheter ablation and AF reinduction on AF EGMs in patients with persistent AF.
  
  
  METHODS
  We collected left atrial EGMs in patients undergoing first ablation for persistent AF at 3 time intervals: (1) AF at baseline; (2) AF after pulmonary vein isolation (PVI); and (3) AF after post-PVI cardioversion and subsequent reinduction. We analyzed 2 EGM spectral characteristics: (1) dominant frequency and (2) spectral complexity; and 2 EGM morphologic characteristics: (1) morphology variation and (2) pattern repetitiveness.
  
  
  RESULTS
  There were no differences in AF dominant frequency, dominant amplitude, spectral complexity, or metrics of EGM morphology or repetitiveness at baseline vs after PVI. However, dominant frequency, dominant amplitude, and spectral complexity differed significantly after direct current cardioversion and reinduction of AF.
  
  
  CONCLUSIONS
  The frequency, spectral complexity, and local EGM morphologies of AF do not significantly change over the course of a PVI procedure in patients with persistent AF. However, reinduction of AF after direct current cardioversion results in different dominant frequency and spectral complexity, consistent with a change in the characteristics of the perpetuating source(s) of the newly induced AF. These data suggest that AF properties can vary significantly between baseline and reinduced AF, with potential clinical ramifications for outcomes of catheter ablation procedures.
authors.affiliation: Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: ab542@columbia.edu.
authors.forename: Angelo B
authors.initials: AB
authors.lastname: Biviano
authors.affiliation: Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Ciaccio
authors.affiliation: Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Knotts
authors.affiliation: Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Jessica
authors.initials: J
authors.lastname: Fleitman
authors.affiliation: Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: John
authors.initials: J
authors.lastname: Lawrence
authors.affiliation: Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Vivek
authors.initials: V
authors.lastname: Iyer
authors.affiliation: Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: William
authors.initials: W
authors.lastname: Whang
authors.affiliation: Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Hasan
authors.initials: H
authors.lastname: Garan
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D004554:Electric Countershock / Q000009:adverse effects / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care
keywords: Atrial fibrillation; Dominant frequency; Electrogram analysis; Linear prediction
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