title: Non-invasive prediction of catheter ablation outcome in persistent atrial fibrillation by fibrillatory wave amplitude computation in multiple electrocardiogram leads.
abstract: BACKGROUND
  Catheter ablation (CA) of persistent atrial fibrillation (AF) is challenging, and reported results are capable of improvement. A better patient selection for the procedure could enhance its success rate while avoiding the risks associated with ablation, especially for patients with low odds of favorable outcome. CA outcome can be predicted non-invasively by atrial fibrillatory wave (f-wave) amplitude, but previous works focused mostly on manual measures in single electrocardiogram (ECG) leads only.
  
  
  OBJECTIVE
  To assess the long-term prediction ability of f-wave amplitude when computed in multiple ECG leads.
  
  
  METHODS
  Sixty-two patients with persistent AF (52 men; mean age 61.5±10.4years) referred for CA were enrolled. A standard 1-minute 12-lead ECG was acquired before the ablation procedure for each patient. F-wave amplitudes in different ECG leads were computed by a non-invasive signal processing algorithm, and combined into a mutivariate prediction model based on logistic regression.
  
  
  RESULTS
  During an average follow-up of 13.9±8.3months, 47 patients had no AF recurrence after ablation. A lead selection approach relying on the Wald index pointed to I, V1, V2 and V5 as the most relevant ECG leads to predict jointly CA outcome using f-wave amplitudes, reaching an area under the curve of 0.854, and improving on single-lead amplitude-based predictors.
  
  
  CONCLUSIONS
  Analysing the f-wave amplitude in several ECG leads simultaneously can significantly improve CA long-term outcome prediction in persistent AF compared with predictors based on single-lead measures.
authors.affiliation: I3S Laboratory, University of Nice Sophia Antipolis, CNRS, Sophia-Antipolis, France. Electronic address: zarzoso@i3s.unice.fr.
authors.forename: Vicente
authors.initials: V
authors.lastname: Zarzoso
authors.affiliation: Cardiology Department, Princess Grace Hospital, Monaco.
authors.forename: Decebal G
authors.initials: DG
authors.lastname: Latcu
authors.affiliation: I3S Laboratory, University of Nice Sophia Antipolis, CNRS, Sophia-Antipolis, France.
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Hidalgo-Muñoz
authors.affiliation: Electrophysiology and Heart Modelling Institute (IHU LIRYC), Bordeaux, France.
authors.forename: Marianna
authors.initials: M
authors.lastname: Meo
authors.affiliation: I3S Laboratory, University of Nice Sophia Antipolis, CNRS, Sophia-Antipolis, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Meste
authors.affiliation: Cardiology Department, Princess Grace Hospital, Monaco.
authors.forename: Irina
authors.initials: I
authors.lastname: Popescu
authors.affiliation: Cardiology Department, Princess Grace Hospital, Monaco.
authors.forename: Nadir
authors.initials: N
authors.lastname: Saoudi
mesh_terms: D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Ablation par cathéter; Amplitude des ondes de fibrillation atriale; Atrial fibrillation; Catheter ablation; Electrocardiography; Fibrillation atriale; Fibrillatory wave amplitude; Prédiction du suivi; Therapy outcome prediction; Électrocardiographie