A novel approach for quantitative electrogram analysis for driver identification: Implications for ablation in persistent atrial fibrillation
ObjectiveThis study sought to study the feasibility, efficacy, and safety of using multiscale entropy (MSE) analysis to guide catheter ablation for persistent atrial fibrillation (PsAF) and predict ablation outcomes.MethodsWe prospectively enrolled 108 patients undergoing initial ablation for PsAF....
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-12-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1049854/full |
| _version_ | 1811213785287884800 |
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| author | Wen-Rui Shi Shao-Hui Wu Guang-Chen Zou Kai Xu Wei-Feng Jiang Yu Zhang Mu Qin Xu Liu |
| author_facet | Wen-Rui Shi Shao-Hui Wu Guang-Chen Zou Kai Xu Wei-Feng Jiang Yu Zhang Mu Qin Xu Liu |
| author_sort | Wen-Rui Shi |
| collection | DOAJ |
| description | ObjectiveThis study sought to study the feasibility, efficacy, and safety of using multiscale entropy (MSE) analysis to guide catheter ablation for persistent atrial fibrillation (PsAF) and predict ablation outcomes.MethodsWe prospectively enrolled 108 patients undergoing initial ablation for PsAF. MSE was calculated based on bipolar intracardiac electrograms (iEGMs) to measure the dynamical complexity of biological signals. The iEGMs data were exported after pulmonary vein isolation (PVI), then calculated in a customed platform, and finally re-annotated into the CARTO system. After PVI, regions of the highest mean MSE (mMSE) values were ablated in descending order until AF termination, or three areas had been ablated.ResultsBaseline characteristics were evenly distributed between the AF termination (n = 38, 35.19%) and the non-termination group. The RA-to-LA mean MSE (mMSE) gradient demonstrated a positive gradient in the non-termination group and a negative gradient in the termination group (0.105 ± 0.180 vs. −0.235 ± 0.256, P < 0.001). During a 12-month follow-up, 29 patients (26.9%) had arrhythmia recurrence after single ablation, and 18 of them had AF (62.1%). The termination group had lower rates of arrhythmia recurrence (15.79 vs. 32.86%, Log-Rank P = 0.053) and AF recurrence (10.53 vs. 20%, Log-Rank P = 0.173) after single ablation and a lower rate of arrhythmia recurrence (7.89 vs. 27.14%, Log-Rank P = 0.018) after repeated ablation. Correspondingly, subjects with negative RA-to-LA mMSE gradient had lower incidences of arrhythmia (16.67 vs. 35%, Log-Rank P = 0.028) and AF (16.67 vs. 35%, Log-Rank P = 0.032) recurrence after single ablation and arrhythmia recurrence after repeated ablation (12.5 vs. 26.67%, Log-Rank P = 0.062). Marginal peri-procedural safety outcomes were observed.ConclusionMSE analysis-guided driver ablation in addition to PVI for PsAF could be feasible, efficient, and safe. An RA < LA mMSE gradient before ablation could predict freedom from arrhythmia. The RA-LA MSE gradient could be useful for guiding ablation strategy selection. |
| first_indexed | 2024-04-12T05:52:02Z |
| format | Article |
| id | doaj.art-874435a125ed42ceb71b0a961aa0a848 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-12T05:52:02Z |
| publishDate | 2022-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-874435a125ed42ceb71b0a961aa0a8482022-12-22T03:45:17ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-12-01910.3389/fcvm.2022.10498541049854A novel approach for quantitative electrogram analysis for driver identification: Implications for ablation in persistent atrial fibrillationWen-Rui Shi0Shao-Hui Wu1Guang-Chen Zou2Kai Xu3Wei-Feng Jiang4Yu Zhang5Mu Qin6Xu Liu7Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Internal Medicine, Danbury Hospital, Danbury, CT, United StatesDepartment of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, ChinaObjectiveThis study sought to study the feasibility, efficacy, and safety of using multiscale entropy (MSE) analysis to guide catheter ablation for persistent atrial fibrillation (PsAF) and predict ablation outcomes.MethodsWe prospectively enrolled 108 patients undergoing initial ablation for PsAF. MSE was calculated based on bipolar intracardiac electrograms (iEGMs) to measure the dynamical complexity of biological signals. The iEGMs data were exported after pulmonary vein isolation (PVI), then calculated in a customed platform, and finally re-annotated into the CARTO system. After PVI, regions of the highest mean MSE (mMSE) values were ablated in descending order until AF termination, or three areas had been ablated.ResultsBaseline characteristics were evenly distributed between the AF termination (n = 38, 35.19%) and the non-termination group. The RA-to-LA mean MSE (mMSE) gradient demonstrated a positive gradient in the non-termination group and a negative gradient in the termination group (0.105 ± 0.180 vs. −0.235 ± 0.256, P < 0.001). During a 12-month follow-up, 29 patients (26.9%) had arrhythmia recurrence after single ablation, and 18 of them had AF (62.1%). The termination group had lower rates of arrhythmia recurrence (15.79 vs. 32.86%, Log-Rank P = 0.053) and AF recurrence (10.53 vs. 20%, Log-Rank P = 0.173) after single ablation and a lower rate of arrhythmia recurrence (7.89 vs. 27.14%, Log-Rank P = 0.018) after repeated ablation. Correspondingly, subjects with negative RA-to-LA mMSE gradient had lower incidences of arrhythmia (16.67 vs. 35%, Log-Rank P = 0.028) and AF (16.67 vs. 35%, Log-Rank P = 0.032) recurrence after single ablation and arrhythmia recurrence after repeated ablation (12.5 vs. 26.67%, Log-Rank P = 0.062). Marginal peri-procedural safety outcomes were observed.ConclusionMSE analysis-guided driver ablation in addition to PVI for PsAF could be feasible, efficient, and safe. An RA < LA mMSE gradient before ablation could predict freedom from arrhythmia. The RA-LA MSE gradient could be useful for guiding ablation strategy selection.https://www.frontiersin.org/articles/10.3389/fcvm.2022.1049854/fullpersistent atrial fibrillationcatheter ablationAF driver mappingmultiscale entropylong-term outcomes |
| spellingShingle | Wen-Rui Shi Shao-Hui Wu Guang-Chen Zou Kai Xu Wei-Feng Jiang Yu Zhang Mu Qin Xu Liu A novel approach for quantitative electrogram analysis for driver identification: Implications for ablation in persistent atrial fibrillation Frontiers in Cardiovascular Medicine persistent atrial fibrillation catheter ablation AF driver mapping multiscale entropy long-term outcomes |
| title | A novel approach for quantitative electrogram analysis for driver identification: Implications for ablation in persistent atrial fibrillation |
| title_full | A novel approach for quantitative electrogram analysis for driver identification: Implications for ablation in persistent atrial fibrillation |
| title_fullStr | A novel approach for quantitative electrogram analysis for driver identification: Implications for ablation in persistent atrial fibrillation |
| title_full_unstemmed | A novel approach for quantitative electrogram analysis for driver identification: Implications for ablation in persistent atrial fibrillation |
| title_short | A novel approach for quantitative electrogram analysis for driver identification: Implications for ablation in persistent atrial fibrillation |
| title_sort | novel approach for quantitative electrogram analysis for driver identification implications for ablation in persistent atrial fibrillation |
| topic | persistent atrial fibrillation catheter ablation AF driver mapping multiscale entropy long-term outcomes |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1049854/full |
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