The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation
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 substra...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/9/6/176 |
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| author | Aikaterini Vraka José Moreno-Arribas Juan M. Gracia-Baena Fernando Hornero Raúl Alcaraz José J. Rieta |
| author_facet | Aikaterini Vraka José Moreno-Arribas Juan M. Gracia-Baena Fernando Hornero Raúl Alcaraz José J. Rieta |
| author_sort | Aikaterini Vraka |
| collection | DOAJ |
| description | 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%, <i>p</i> = 0.0017, LR: max. +5.33%, <i>p</i> = 0.0002) and comparison between two ablation steps (max. +54.07%, <i>p</i> = 0.0205). HRA significantly enhanced these relationships, especially in duration (P-wave/LAW: +43.82% to +69.91%, <i>p</i> < 0.0001 for PC and +18.97% to +47.25%, <i>p</i> < 0.0001 for LR, CA effect: +53.90% to +85.72%, <i>p</i> < 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. |
| first_indexed | 2024-03-09T23:29:05Z |
| format | Article |
| id | doaj.art-38a741aea67e4860b7a3d87424d5d47a |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-09T23:29:05Z |
| publishDate | 2022-06-01 |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-38a741aea67e4860b7a3d87424d5d47a2023-11-23T17:12:29ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252022-06-019617610.3390/jcdd9060176The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial FibrillationAikaterini Vraka0José Moreno-Arribas1Juan M. Gracia-Baena2Fernando Hornero3Raúl Alcaraz4José J. Rieta5BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, SpainCardiology Department, Saint John’s University Hospital, 03550 Alicante, SpainCardiovascular Surgery Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, SpainCardiovascular Surgery Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, SpainResearch Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 16071 Cuenca, SpainBioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, SpainCoronary 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%, <i>p</i> = 0.0017, LR: max. +5.33%, <i>p</i> = 0.0002) and comparison between two ablation steps (max. +54.07%, <i>p</i> = 0.0205). HRA significantly enhanced these relationships, especially in duration (P-wave/LAW: +43.82% to +69.91%, <i>p</i> < 0.0001 for PC and +18.97% to +47.25%, <i>p</i> < 0.0001 for LR, CA effect: +53.90% to +85.72%, <i>p</i> < 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.https://www.mdpi.com/2308-3425/9/6/176atrial fibrillationcatheter ablationcoronary sinusP-wavescorrelationatrial substrate |
| spellingShingle | Aikaterini Vraka José Moreno-Arribas Juan M. Gracia-Baena Fernando Hornero Raúl Alcaraz José J. Rieta The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation Journal of Cardiovascular Development and Disease atrial fibrillation catheter ablation coronary sinus P-waves correlation atrial substrate |
| title | The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation |
| title_full | The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation |
| title_fullStr | The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation |
| title_full_unstemmed | The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation |
| title_short | The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation |
| title_sort | relevance of heart rate fluctuation when evaluating atrial substrate electrical features in catheter ablation of paroxysmal atrial fibrillation |
| topic | atrial fibrillation catheter ablation coronary sinus P-waves correlation atrial substrate |
| url | https://www.mdpi.com/2308-3425/9/6/176 |
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