The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation.
Aikaterini VrakaJosé Moreno-ArribasJuan Manuel Gracia BaenaFernando HorneroRaúl AlcarazJosé Joaquín RietaPublished in: Journal of cardiovascular development and disease (2022)
Coronary sinus (CS) catheterization is critical during catheter ablation (CA) of atrial fibrillation (AF). However, the association of CS electrical activity with atrial substrate modification has been barely investigated and mostly limited to analyses during AF. In sinus rhythm (SR), atrial substrate modification is principally assessed at a global level through P-wave analysis. Cross-correlating CS electrograms (EGMs) and P-waves' features could potentiate the understanding of AF mechanisms. Five-minute surface lead II and bipolar CS recordings before, during, and after CA were acquired from 40 paroxysmal AF patients. Features related to duration, amplitude, and heart-rate variability of atrial activations were evaluated. Heart-rate adjustment (HRA) was applied. Correlations between each P-wave and CS local activation wave (LAW) feature were computed with cross-quadratic sample entropy (CQSE), Pearson correlation (PC), and linear regression (LR) with 10-fold cross-validation. The effect of CA between different ablation steps was compared with PC. Linear correlations: poor to mediocre before HRA for analysis at each P-wave/LAW (PC: max. +18.36%, p = 0.0017, LR: max. +5.33%, p = 0.0002) and comparison between two ablation steps (max. +54.07%, p = 0.0205). HRA significantly enhanced these relationships, especially in duration (P-wave/LAW: +43.82% to +69.91%, p < 0.0001 for PC and +18.97% to +47.25%, p < 0.0001 for LR, CA effect: +53.90% to +85.72%, p < 0.0210). CQSE reported negligent correlations (0.6-1.2). Direct analysis of CS features is unreliable to evaluate atrial substrate modification due to CA. HRA substantially solves this problem, potentiating correlation with P-wave features. Hence, its application is highly recommended.
Keyphrases
- atrial fibrillation
- catheter ablation
- heart rate
- heart rate variability
- left atrial
- left atrial appendage
- oral anticoagulants
- blood pressure
- direct oral anticoagulants
- heart failure
- percutaneous coronary intervention
- protein kinase
- newly diagnosed
- end stage renal disease
- ejection fraction
- magnetic resonance imaging
- coronary artery disease
- deep learning
- patient reported outcomes
- computed tomography
- coronary artery
- magnetic resonance
- machine learning
- acute coronary syndrome
- structural basis
- left ventricular