An Evaluation of Phase Analysis to Interpret Atrial Activation Patterns during Persistent Atrial Fibrillation for...

Area of Science:

• Electrophysiology
• Cardiovascular Research
• Medical Imaging Analysis

Background:

• Phase analysis is a common method for identifying atrial fibrillation (AF) sources for ablation.
• Previous work indicated that incomplete reentries can be misinterpreted as stable rotors by phase analysis.
• Inaccurate detection of phase inversion points in atrial electrograms (AEGs) may cause misinterpretations.

Purpose of the Study:

• To evaluate the accuracy of phase analysis in detecting atrial activations during persistent and long-standing persistent (LSP) AF.
• To assess the reliability of phase analysis for high-density mapping of AF.

Main Methods:

• Simultaneous atrial activation recording using 512 electrodes in 7 patients undergoing open-heart surgery.
• Comparison of phase analysis results with manual measurements over 4-second data intervals.
• Definition of successful recording sites based on ≤4 mismatched activation times.

Main Results:

• Phase analysis accuracy was 82% for activation times, with discrepancies due to time differences, under-sensing, and over-sensing.
• Only 67.9% of recording sites met the criteria for successful phase analysis.
• Inaccurate sites were associated with irregular cycle length, complex AEGs, and double potentials.

Conclusions:

• Phase analysis demonstrates reduced accuracy in areas with irregular cycle lengths, complex AEGs, or double potentials.
• The findings suggest phase analysis can lead to misinterpretation of atrial activation patterns in AF.
• Visual review of original AEGs is recommended to validate AF source identification before targeted ablation.