title: Atrial Tachycardias After Atrial Fibrillation Ablation Manifest Different Waveform Characteristics: Implications for Characterizing Tachycardias.
abstract: BACKGROUND
  Atrial fibrillation (AF) ablation patients often manifest atrial tachycardias (AT) with atypical ECG morphologies that preclude accurate localization and mechanism. Diagnostic maneuvers used to define ATs during electrophysiology studies can be limited by tachycardia termination or transformation. Additional methods of characterizing post-AF ablation ATs are required.
  
  
  RESULTS
  We evaluated the utility of noninvasive ECG signal analytics in postablation AF patients for the following features: (1) Localization of ATs (i.e., right vs. left atrium), and (2) Identification of common left AT mechanisms (i.e., focal vs. macroreentrant). Atrial waveforms from the surface ECG were used to analyze (1) spectral organization, including dominant amplitude (DA) and mean spectral profile (MP), and (2) temporospatial variability, using temporospatial correlation coefficients. We studied 94 ATs in 71 patients who had undergone prior pulmonary vein isolation for AF and returned for a second ablation: (1) right atrial cavotricuspid-isthmus dependent (CTI) ATs (n = 21); (2) left atrial macroreentrant ATs (n = 41) and focal ATs (n = 32). Right CTI ATs manifested higher DAs and lower MPs than left ATs, indicative of greater stability and less complexity in the frequency spectrum. Left macroreentrant ATs possessed higher temporospatial organization than left focal ATs.
  
  
  CONCLUSIONS
  Noninvasively recorded atrial waveform signal analyses show that right ATs possess more stable activation properties than left ATs, and left macroreentrant ATs manifest higher temporospatial organization than left focal ATs. Further prospective analyses evaluating the role these novel ECG-derived tools can play to help localize and identify mechanisms of common ATs in AF ablation patients are warranted.
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.|Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Angelo B
authors.initials: AB
authors.lastname: Biviano
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.|Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Ciaccio
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.|Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Fleitman
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.|Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Knotts
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.|Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: John
authors.initials: J
authors.lastname: Lawrence
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.|Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Norrisa
authors.initials: N
authors.lastname: Haynes
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.|Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Cyrille
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.|Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Hickey
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.|Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Iyer
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.|Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Wan
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.|Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: William
authors.initials: W
authors.lastname: Whang
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.|Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Hasan
authors.initials: H
authors.lastname: Garan
keywords: atrial fibrillation; atrial flutter; atrial tachycardia; catheter ablation; electrocardiography; spectral analysis