Key result
Non-invasive ECGI moderately correlates with intracardiac atrial activation mapping within a ~0.10 Hz difference.
Why the study?
To determine whether non-invasive assessment of regional AF activation rates accurately reflects intracardiac recordings to help guide ablation or anti-arrhythmic therapy.
Does non-invasive Electrocardiographic Imaging accurately represent intracardiac recordings of regional AF rate in patients with atrial fibrillation?
Observational (n=47)
Yes
Does non-invasive Electrocardiographic Imaging accurately represent intracardiac recordings of regional AF rate in patients with atrial fibrillation?
Non-invasive estimation of atrial activation rates using ECGI is feasible and provides a moderate estimate of intracardiac rates when filtered by high spectral organization, potentially aiding in personalized AF ablation therapy.
Filtered ECGI approximates intracardiac DF and associates with ablation success; hypothesis-generating for non-invasive AF mapping pending prospective trials.
Introduction: Regional differences in activation rates may contribute to the electrical substrates that maintain atrial fibrillation (AF), and estimating them non-invasively may help guide ablation or select anti-arrhythmic medications. We tested whether non-invasive assessment of regional AF rate accurately represents intracardiac recordings. Methods: In 47 patients with AF (27 persistent, age 63 ± 13 years) we performed 57-lead non-invasive Electrocardiographic Imaging (ECGI) in AF, simultaneously with 64-pole intracardiac signals of both atria. ECGI was reconstructed by Tikhonov regularization. We constructed personalized 3D AF rate distribution maps by Dominant Frequency (DF) analysis from intracardiac and non-invasive recordings. Results: Raw intracardiac and non-invasive DF differed substantially, by 0.54 Hz [0.13 – 1.37] across bi-atrial regions (R2 = 0.11). Filtering by high spectral organization reduced this difference to 0.10 Hz (cycle length difference of 1 – 11 ms) [0.03 – 0.42] for patient-level comparisons (R2 = 0.62), and 0.19 Hz [0.03 – 0.59] and 0.20 Hz [0.04 – 0.61] for median and highest DF, respectively. Non-invasive and highest DF predicted acute ablation success (p = 0.04). Conclusion: Non-invasive estimation of atrial activation rates is feasible and, when filtered by high spectral organization, provide a moderate estimate of intracardiac recording rates in AF. Non-invasive technology could be an effective tool to identify patients who may respond to AF ablation for personalized therapy.
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Rodrigo et al. (2021) conducted an observational in Atrial fibrillation (n=47). Non-invasive Electrocardiographic Imaging (ECGI) vs. Intracardiac contact mapping was evaluated on Correlation of Dominant Frequency (DF) between non-invasive and intracardiac mapping after filtering by high spectral organization (R2= 0.62). Non-invasive estimation of atrial activation rates using Electrocardiographic Imaging, when filtered by high spectral organization, moderately correlated with intracardiac mapping (R2=0.62) with a median difference of 0.10 Hz.
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