Key result
Patients with procedural AF termination had higher median kurtosis of the fractionation interval histogram at fractionated electrogram sites than those without termination (2.69 vs 2.35; P=0.024).
Why the study?
Does kurtosis analysis of fractionation interval histograms identify critical substrates for procedural termination in patients with persistent AF undergoing catheter ablation?
Observational (n=52)
Does kurtosis analysis of fractionation interval histograms identify critical substrates for procedural termination in patients with persistent AF undergoing catheter ablation?
Absolute Event Rate: 2.69% vs 2.35%
p-value: p=0.024
Kurtosis analysis of fractionation interval histograms may help identify critical substrates for persistent AF and predict responders to catheter ablation.
May aid identification of termination sites; extends electrogram analyses but leaves open whether kurtosis-guided ablation improves outcomes.
BACKGROUND: The characteristics of atrial electrograms associated with atrial fibrillation (AF) termination are controversial. We investigated the electrogram characteristics that indicate procedural AF termination during continuous complex fractionated electrogram ablation. METHODS AND RESULTS: Fifty-two consecutive patients with persistent AF (47 men; aged 54 ± 9 years), who underwent electrogram-based catheter ablation in the left atrium and coronary sinus after pulmonary vein isolation, were enrolled. The intracardiac bipolar atrial electrogram recordings were characterized by (1) fractionation interval (FI) analysis (>6 seconds), (2) kurtosis (shape of the FI histogram), and (3) skewness (asymmetry of the FI histogram). Sites showing complex, fractionated electrograms (mean FI ≤ 60 ms) were targeted, and AF was terminated in 20 patients (38%) after the pulmonary vein isolation. The conventional complex fractionated electrogram sites (mean ≤ 120 ms) in patients with AF termination exhibited higher median kurtosis (2.69 [interquartile range, 2.03-3.46] versus 2.35 [interquartile range, 1.79-2.48]; P=0.024) and higher complex fractionated electrogram-mean interval (102.7 ± 19.8 versus 87.7 ± 15.0; P=0.008) than patients without AF termination. Furthermore, AF termination sites had higher median kurtosis than targeted sites without AF termination (5.13 [interquartile range, 3.51-6.47] versus 4.18 [interquartile range, 2.91-5.34]; P<0.01) in patients with procedural termination. In addition, patients with AF termination had a higher sinus rhythm maintenance rate after a single procedure than patients without AF termination (log-rank test, P=0.007). CONCLUSIONS: A kurtosis analysis using the FI histogram may be a useful tool in identifying the critical substrate for persistent AF and potential responders to catheter ablation.
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Lin et al. (2012) conducted an observational in Persistent Atrial Fibrillation (n=52). Procedural AF termination vs. No procedural AF termination was evaluated on Median kurtosis at conventional complex fractionated electrogram sites (p=0.024). Patients with procedural AF termination had higher median kurtosis of the fractionation interval histogram at fractionated electrogram sites than those without termination (2.69 vs 2.35; P=0.024).
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