Key result
The electrogram quality index and spectral power index accurately predicted acute termination of persistent atrial fibrillation during ablation, yielding AUCs of 0.86 and 0.85, respectively.
Why the study?
Termination of AF during catheter ablation is an attractive procedural endpoint, but it is not clear whether termination can be predicted using clinical data.
Do quantitative electrogram indices (SPI and EQI) predict acute termination of atrial fibrillation during catheter ablation in patients with persistent AF?
Observational (n=42)
No
Do quantitative electrogram indices (SPI and EQI) predict acute termination of atrial fibrillation during catheter ablation in patients with persistent AF?
The Spectral Power Index and Electrogram Quality Index derived from pre-ablation multielectrode recordings can accurately predict whether catheter ablation will acutely terminate persistent atrial fibrillation.
EQI and SPI may aid prediction of acute termination during persistent AF ablation; hypothesis-generating and requires prospective validation.
Background: Termination of atrial fibrillation (AF), the most common arrhythmia in the United States, during catheter ablation is an attractive procedural endpoint, which has been associated with improved long-term outcome in some studies. It is not clear, however, whether it is possible to predict termination using clinical data. We developed and applied three quantitative indices in global multielectrode recordings of AF prior to ablation: average dominant frequency (ADF), spectral power index (SPI), and electrogram quality index (EQI). Methods: In N = 42 persistent AF patients (65 ± 9 years, 14% female) we collected unipolar electrograms from 64-pole baskets (Abbott, CA). We studied N = 17 patients in whom AF terminated during ablation (“Term”) and N = 25 in whom it did not (“Non-term”). For each index, we determined its ability to predict ablation by computing receiver operating characteristic (ROC) and calculated the area under the curve (AUC). Results: The ADF did not differ for Term and Non-term patients at 5.28 ± 0.82 Hz and 5.51 ± 0.81 Hz, respectively ( p = 0.34). Conversely, the SPI for these two groups was. 0.85 (0.80–0.92) and 0.97 (0.93–0.98) and the EQI was 0.61 (0.58–0.64) and 0.56 (0.55–0.59) ( p < 0.0001). The AUC for predicting AF termination for the SPI was 0.85 ([0.68, 0.95] 95% CI), and for the EQI, 0.86 ([0.72, 0.95] 95% CI). Conclusion: Both the EQI and the SPI may provide a useful clinical tool to predict procedural ablation outcome in persistent AF patients. Future studies are required to identify which physiological features of AF are revealed by these indices and hence linked to AF termination or non-termination.
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Kappel et al. (2022) conducted an observational in Persistent atrial fibrillation (n=42). Electrogram Quality Index (EQI) and Spectral Power Index (SPI) vs. Average Dominant Frequency (ADF) was evaluated on Prediction of acute AF termination using Electrogram Quality Index (EQI) (AUC 0.86, 95% CI 0.72, 0.95, p=<0.0001). The electrogram quality index and spectral power index accurately predicted acute termination of persistent atrial fibrillation during ablation, yielding AUCs of 0.86 and 0.85, respectively.
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