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Regions of Highly Recurrent Electrogram Morphology With Low Cycle Length Reflect Substrate for Atrial Fibrillation
Shin Yoo1, Markus Rottmann1, Jason Ng1
1Feinberg Cardiovascular and Renal Research Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
JACC. Basic to Translational Science
|February 13, 2023
Summary
Electrogram morphology recurrence (EMR) shows promise as a new target for persistent atrial fibrillation (AF) ablation. This study links EMR to stable rotational activity and nerve fiber distribution, suggesting a novel therapeutic approach for AF.
Area of Science:
- Electrophysiology
- Cardiac Arrhythmias
- Computational Biology
Background:
- Current treatments for persistent atrial fibrillation (AF), including anatomical and electrogram-guided ablation, are insufficient.
- Persistent AF requires novel therapeutic targets beyond established electrogram parameters.
Purpose of the Study:
- To investigate the relationship between electrogram morphology recurrence (EMR) and established AF electrogram parameters.
- To explore the correlation of EMR with atrial tissue characteristics, including rotational activity and parasympathetic nerve distribution.
Main Methods:
- Biatrial high-density electrophysiologic mapping was performed in a canine rapid atrial pacing model of AF.
- Systematic investigation of electrogram morphology recurrence (Rec% and CLR) parameters.
Main Results:
- EMR parameters, specifically Rec%, were found to correlate with the stability of rotational activity during AF.
- Rec% also demonstrated a correlation with the spatial distribution of parasympathetic nerve fibers in the atria.
Conclusions:
- Electrogram morphology recurrence (EMR) represents a potential new therapeutic target for persistent AF.
- Targeting EMR may offer a more effective strategy for managing persistent atrial fibrillation.
Keywords:
AF, atrial fibrillationAI, anisotropy indexCFAE, complex fractionated atrial electrogramCLR, cycle length of the most recurrent electrogram morphologyDF, dominant frequencyEGM, electrogramEMR, electrogram morphology recurrenceFFT, fast Fourier transformFI, fractionation intervalFIRM, focal impulse and rotor mappingLAA, left atrial appendageLAFW, left atrial free wallLAT, local activation timeOI, organization indexPLA, posterior left atriumPV, pulmonary veinRAA, right atrial appendageRAFW, right atrial free wallRAP, rapid atrial pacingRec%, recurrence percentageShEn, Shannon’s entropyarrhythmiasatrial fibrillationfibrosismappingMore Related Videos
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