Standardization and validation of an automated algorithm to identify fractionation as a guide for atrial fibrillation ablation.

BACKGROUND Atrial fibrillation catheter ablation is frequently guided by identification of fractionated electrograms, which are thought to be critical for maintenance of the arrhythmia. Objective automated means for identifying fractionation independent of physician interpretation have not been standardized or validated. OBJECTIVE The purpose of this study was to standardize and validate an automated algorithm to rapidly identify fractionated electrograms for high-density atrial fibrillation fractionation mapping. METHODS Left and right atrial fractionation maps were generated by EnSite NavX 6.0 software, using standardized ablation catheters in eight patients with atrial fibrillation. Two blinded electrophysiologists interpreted all electrograms as either fractionated or not fractionated. A stepwise approach was used to optimize automated settings to accurately identify fractionation. High-density fractionation maps were generated with a 20-pole mapping catheter in eight other patients. Two blinded electrophysiologists interpreted all electrograms as near field or far field. The algorithm was refined to optimize settings to exclude far-field signals and retain near-field signals. The sampling segment length was adjusted to optimize recording time to ensure reproducibility. RESULTS Using 1,514 points, the automated software achieved sensitivity of 0.75 and specificity of 0.80 for identification of fractionated electrograms. Using 725 points collected via multipole catheters with optimal automated settings, 94% of near-field fractionated electrograms were accurately identified. A 6-second sampling length was needed for reproducible fractionation measurements. CONCLUSION Standardized settings of EnSite NavX 6.0 software with 6-second data collection per point can rapidly and accurately generate high-density fractionation maps independent of physician electrogram interpretation. This may allow for an automated, standardized approach to atrial fibrillation fractionated ablation.

[1]  Frank Bogun,et al.  Radiofrequency Catheter Ablation of Chronic Atrial Fibrillation Guided by Complex Electrograms , 2007, Circulation.

[2]  David O. Martin,et al.  Efficacy of Adjuvant Anterior Left Atrial Ablation During Intracardiac Echocardiography‐Guided Pulmonary Vein Antrum Isolation for Atrial Fibrillation , 2007, Journal of cardiovascular electrophysiology.

[3]  F. Marchlinski,et al.  Presence of Left-to-Right Atrial Frequency Gradient in Paroxysmal but Not Persistent Atrial Fibrillation in Humans , 2004, Circulation.

[4]  Prashanthan Sanders,et al.  Characterization of electrograms associated with termination of chronic atrial fibrillation by catheter ablation. , 2008, Journal of the American College of Cardiology.

[5]  OmerBerenfeld,et al.  Spectral Analysis Identifies Sites of High-Frequency Activity Maintaining Atrial Fibrillation in Humans , 2005 .

[6]  Atul Verma,et al.  A prospective, multicenter evaluation of ablating complex fractionated electrograms (CFEs) during atrial fibrillation (AF) identified by an automated mapping algorithm: acute effects on AF and efficacy as an adjuvant strategy. , 2008, Heart rhythm.

[7]  Hugh Calkins,et al.  Automated detection and characterization of complex fractionated atrial electrograms in human left atrium during atrial fibrillation. , 2007, Heart rhythm.

[8]  M. Allessie,et al.  High-density mapping of electrically induced atrial fibrillation in humans. , 1994, Circulation.

[9]  Prashanthan Sanders,et al.  Spectral Analysis Identifies Sites of High-Frequency Activity Maintaining Atrial Fibrillation in Humans , 2005, Circulation.

[10]  Shih-Ann Chen,et al.  Consistency of complex fractionated atrial electrograms during atrial fibrillation. , 2008, Heart rhythm.

[11]  C. Tai,et al.  Prolonged fractionation of paced right atrial electrograms in patients with atrial flutter and fibrillation. , 2001, Journal of the American College of Cardiology.

[12]  M. Allessie,et al.  Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans. , 1997, Circulation.

[13]  Claus Schmitt,et al.  Characterization of Paroxysmal and Persistent Atrial Fibrillation in the Human Left Atrium During Initiation and Sustained Episodes , 2002, Journal of cardiovascular electrophysiology.

[14]  A. Waldo,et al.  Radiofrequency Catheter Ablation of Chronic Atrial Fibrillation Guided by Complex Electrograms , 2008 .

[15]  Robert Ploutz-Snyder,et al.  Mechanisms of Wave Fractionation at Boundaries of High-Frequency Excitation in the Posterior Left Atrium of the Isolated Sheep Heart During Atrial Fibrillation , 2006, Circulation.

[16]  Prashanthan Sanders,et al.  The Effect of Electrogram Duration on Quantification of Complex Fractionated Atrial Electrograms and Dominant Frequency , 2008, Journal of cardiovascular electrophysiology.

[17]  K. Nademanee,et al.  A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. , 2004, Journal of the American College of Cardiology.

[18]  Prashanthan Sanders,et al.  High-density activation mapping of fractionated electrograms in the atria of patients with paroxysmal atrial fibrillation. , 2006, Heart rhythm.