What question did this study set out to answer?

To test whether the spatial extent of repetitive, synchronized electrogram patterns identifies a pathophysiological spectrum that predicts acute catheter ablation termination in patients with atrial tachyarrhythmias.

March 18, 2023EP EuropaceOpen Access

Quantifying a spectrum of clinical response in atrial tachyarrhythmias using spatiotemporal synchronization of electrograms

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Why the study?

Although patients with atrial tachyarrhythmias show a spectrum of response to ablation, whether this clinical spectrum has pathophysiological signatures was undefined.

Does the size of spatial regions showing repetitive synchronized electrograms (REACT) predict acute response to ablation in patients with atrial tachyarrhythmias?

Key Points

To test whether the spatial extent of repetitive, synchronized electrogram patterns identifies a pathophysiological spectrum that predicts acute catheter ablation termination in patients with atrial tachyarrhythmias.
Analyzed N=160 patients (35% women, mean age 65.0 ± 10.4 years) comprising 10 with atrial tachycardia and 150 with atrial fibrillation, propensity-matched by acute ablation termination status (n=75 terminated vs. n=75 non-terminated).
Mapped atrial electrograms with 64-pole basket catheters to quantify regions of repetitive activity (REACT) via unipolar shape synchronization over time, evaluating findings with computational simulations and unsupervised machine learning across 50 clinical variables.
Synchronized electrogram areas (REACT) progressively declined across clinical groups, measuring 0.63 ± 0.15 in atrial tachycardia, 0.37 ± 0.22 in terminated atrial fibrillation, and 0.22 ± 0.18 in non-terminated atrial fibrillation (P < 0.001).
REACT predicted acute atrial fibrillation termination with an area under the receiver operating characteristic curve of 0.72 ± 0.03 in hold-out validation cohorts.
Unsupervised machine learning incorporating REACT and 50 clinical variables generated four risk clusters for ablation non-termination (P < 0.01), yielding significantly higher predictive power than clinical profiles alone (P < 0.001).

Structured PICO

Does the size of spatial regions showing repetitive synchronized electrograms (REACT) predict acute response to ablation in patients with atrial tachyarrhythmias?

Population

160 patients with atrial tachyarrhythmias (mean age 65.0 ± 10.4 years, 35% women), comprising 75 with AF terminated by ablation, 75 propensity-matched patients without AF termination, and 10 with atrial tachycardia (AT).

Intervention

Mapping by 64-pole baskets to identify areas of repetitive activity (REACT) to correlate unipolar EGMs in shape over time.

Comparator

Comparison between patients with AT, AF with acute termination by ablation, and AF without acute termination.

Outcome

Size of spatial regions showing repetitive synchronized electrogram (EGM) shapes over time (REACT).surrogate

The area of synchronized electrograms within the atrium correlates with the clinical spectrum of atrial tachyarrhythmias and predicts acute response to ablation in atrial fibrillation.

Discussion

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Implication

May identify ablation targets across the AT-AF spectrum; leaves open whether EMR mapping improves outcomes in prospective trials.

Cite This Study

Ganesan et al. (2023) studied this question.

synapsesocial.com/papers/6a923f4943dadb0f154362ba https://doi.org/10.1093/europace/euad055

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes

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Quantifying a spectrum of clinical response in atrial tachyarrhythmias using spatiotemporal synchronization of electrograms

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Quantifying a spectrum of clinical response in atrial tachyarrhythmias using spatiotemporal synchronization of electrograms

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider