Dynamics of Intraprocedural Dominant Frequency Identifies Ablation Outcome in Persistent Atrial Fibrillation

Figures

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  Figure 1. Dominant frequency estimation on 10-s epochs recorded from the LAA, RAA, and the ECG leads V1 and V6b in an LT_SR patient at baseline and after 20 min of cumulative CFAEs and linear ablation. For the surface ECG recordings, the atrial V1 and V6b signals represent the ECG leads V1 and V6b devoid of ventricular activity. The corresponding power spectral densities (normalized by their maximum value) and the estimated DFs are illustrated in the right column. DF, dominant frequency; %DF, relative change in DF during ablation compared with baseline DF values. Other abbreviations as in previous tables.

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  Figure 2. ROC curve for baseline DF computed from the RAA (A) and lead V1 (C). (B,D) Show the distribution of RAA and V1 DF values, respectively, grouped by the procedural outcome (NLT, LT_Rec, and LT_SR). The horizontal dashed lines indicate the optimal cutoff points for DF above which both procedural AF termination and SR maintenance at follow-up were less likely to be achieved by ablation. Abbreviations as in Table 3.

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  Figure 3. Relative changes (%) in DF compared with the baseline DF at the end of PVI (endPVI) and during the first 10, 20, and 30 min of cumulative ablation following PVI. DF was measured within the LAA, RAA, CS, and on the ECG leads V1 and V6b. RFA, radiofrequency ablation. Abbreviations as in previous tables and figures.

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  Figure 4. Temporal evolution of DF measured on 10-s epochs recorded from the LAA in an LT_SR patient (top), an LT_Rec patient (middle), and an NLT patient (bottom) at baseline (BL), at the end of PVI (end_PVI), and during LA ablation (CFAEs and linear ablation). Each dot represents the DF value computed on a single 10-s epoch. Average DFs at baseline and during the first 10, 20, and 30 min of cumulative ablation following PVI are represented by the horizontal blue, red, green, and magenta lines, respectively. PVI, pulmonary vein isolation; RFA, radiofrequency ablation; ΔDF, relative change in DF during ablation compared with the baseline DF value. Other abbreviations as in previous tables and figures.

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  Figure 5. Predictive performance of DF for long-term SR maintenance. (A) Decision tree model based on the relative changes in LAA DF after the first 20 min of LA ablation and baseline RAA DF. (B) Kaplan–Meier curves for freedom from AF recurrence after catheter ablation. Abbreviations as in previous figures.