Atrial extrasystoles enhance low-voltage fractionation electrograms in patients with atrial fibrillation

Figures

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  Figure 1. Examples of SR beats and AES recorded at various atrial sites. Four examples of 5 s SR recordings including AES and corresponding colour-coded activation maps and EGMs. Thick black lines in the activation maps correspond with conduction block according to a time difference between adjacent electrodes of ≥12 ms. For each patient, the PI, and average difference in wavefront direction, potential voltage, LVAs, amount of SP, SDP, LDP, and FP and their corresponding FD is given. Upper left panel: One SR beat and a mild-premature, non-aberrant AES (origin right-sided) recorded at the RA. Although average potential voltages decreased, several electrodes demonstrate a local increase in potential voltages. Potential morphology was comparable between SR and AES. Upper right panel: One SR beat and a moderate premature AES with mild/opposite aberrancy (origin left-sided) recorded at BB. Compared with SR, the AES resulted in a decrease of potential voltages and an increase in the number of SDPs, LDPs and FPs. Lower left panel: One SR beat and a moderate premature AES with severe aberrancy (origin left-sided) recorded at the PVA. There was a large spatial variability in potential voltage…

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  Figure 2. Relation between prematurity index and potential characteristics. In each panel, prematurity indices are plotted against each of the EGM parameters. Each individual AES is indicated by a dot of which colour indicates the average provoked effect. The colour scale ranges from the smallest to the largest effect of all AES. The black line indicates the linear correlation between prematurity index and the effect provoked by all AES. Four (none, mild, moderate, severe) prematurity classes are separately highlighted by a grayscale, ranging from light grey to dark grey, respectively. The average for each class is coloured according to the mean effect, ranging from 0 to the maximum difference of all classes. AES, atrial extrasystole; DP, short + long double potentials; FD, fractionation duration; FP, fractionated potentials; LDP, long double potentials; LVA, low-voltage area; SDP, short double potentials; SP, single potentials.

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  Figure 3. Relation between aberrancy and potential characteristics. In each panel, the absolute difference in propagation direction for each AES is plotted against the various EGM parameters in polar plots. Each individual AES is indicated by a dot of which colour indicates the average provoked effect. The colour scale ranges from the smallest to the largest effect of all AES. Four (none, mild/opposite, moderate, severe) aberrancy classes are separately highlighted by a grayscale, ranging from light grey to dark grey, respectively. The average for each class is coloured according to the mean effect ranging from 0 to the maximum difference of all classes. AES, atrial extrasystole; DP, short + long double potentials; FD, fractionation duration; FP, fractionated potentials; LDP, long double potentials; LVA, low-voltage area; SDP, short double potentials; SP, single potentials.

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  Figure 4. Interrelationship between aberrancy and prematurity. The mean effect of each parameter is visualized for all AES with varying degrees of aberrancy (x-axis) and prematurity (y-axis). The size and colour (from green to red) of the squares represent the mean effect provoked by the AES in each class. DP, short + long double potentials; FD, fractionation duration; FP, fractionated potentials; LDP, long double potentials; LVA, low-voltage area; SDP, short double potentials; SP, single potentials.