Regional Dominant Frequency: A New Tool for Wave Break Identification During Atrial Fibrillation

Cardiac mapping systems are based on the time/frequency feature analyses of intracardiac electrograms recorded from individual bipolar/unipolar electrodes. Signals from each electrode are processed independently. Such approaches fail to investigate the interrelationship between simultaneously recorded channels of any given mapping catheter during atrial fibrillation (AF). We introduce a novel signal processing technique that reflects regional dominant frequency (RDF) components. We show that RDF can be used to identify and characterize variation and disorganization in wavefront propagation- wave breaks. The intracardiac electrograms from the left atrium of 15 patients were exported to MATLAB and custom software employed to estimate RDF and wave break rate (WBR). We observed a heterogeneous distribution of both RDF and WBR; the two measures were weakly correlated (0.3; p < 0.001). We identified locations of AF or atrial tachycardia (ATach) termination and later compared offline with RDF and WBR maps. We inspected our novel metrics for associations with AF termination sites. Areas associated with AF termination demonstrated high RDF and low WBR (↑RDF,↓WBR). These sites were present in 14 of 15 patients (mean 2.6 ± 1.2 sites per patient; range, 1-4 sites), 43% situated within the pulmonary veins. In nine patients where AF terminated to sinus rhythm (6) or ATach (3), post-hoc analysis demonstrated all ↑RDF,↓WBR sites were ablated and correlated with AF termination sites. The proposed RDF signal processing tools can be used to identify and quantify wave break, and the combined use of these two novel metrics can aid characterization of AF. Further prospective studies are warranted.