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Minimizing discordances in automated classification of fractionated electrograms in human persistent atrial fibrillation

Tiago P. Almeida, Gavin S. Chu, João L. Salinet, Frederique J. Vanheusden, Xin Li, Jiun H. Tuan, Peter J. Stafford, G. André Ng, Fernando S. Schlindwein
2016 Medical and Biological Engineering and Computing  
Abstract Ablation of persistent atrial fibrillation (per-sAF) targeting complex fractionated atrial electrograms (CFAEs) detected by automated algorithms has produced conflicting outcomes in previous electrophysiological  ...  This could facilitate comparisons of CFAE ablation outcomes guided by either NavX or CARTO in future works.  ...  distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in  ... 
doi:10.1007/s11517-016-1456-2 pmid:26914407 pmcid:PMC5069340 fatcat:ai2zxxq6obgwjcplgrhyhi3pee

Rotors and Focal Sources for Human Atrial Fibrillation

Gautam G. Lalani, Rishi Trikha, David E. Krummen, Sanjiv M. Narayan
2014 Circulation Journal  
Third, we developed signal processing methods to map human AF based on our studies of repolarization, 63-66 conduction, 65,67 and electrogram phase 68-71 in relation to AF. 64, 72 These studies led to  ...  Treatment of atrial fibrillation by the ablation of localized sources: The conventional ablation for atrial fibrillation with or with- out focal impulse and rotor modulation [CONFIRM] Trial.  ... 
doi:10.1253/circj.cj-14-0478 pmid:25213002 fatcat:ygk552mfwfbnzomivx6bqn2qju

Ablation of Atrial Fibrillation Drivers

Tina Baykaner, Junaid A B Zaman, Paul J Wang, Sanjiv M Narayan
2017 Arrhythmia & Electrophysiology Review  
Pulmonary vein isolation (PVI) is central to ablation approaches for atrial fibrillation (AF), yet many patients still have arrhythmia recurrence after one or more procedures, despite evolving technologies  ...  Such localised drivers lie in atrial regions shown mechanistically to sustain AF in optical mapping and clinical studies of human AF, as well as computational and animal studies.  ...  A learning curve exists in optimum basket placement, interpretation of AF maps, and ablation guidance based on maps.  ... 
doi:10.15420/2017:28:1 pmid:29326835 pmcid:PMC5739904 fatcat:iz7bor7o4na55pp4l4ut3fqlra

The continuous challenge of AF ablation: From foci to rotational activity

Sanjiv M. Narayan, Mohan N. Vishwanathan, Christopher A.B. Kowalewski, Tina Baykaner, Miguel Rodrigo, Junaid A.B. Zaman, Paul J. Wang
2017 Revista Portuguesa de Cardiologia  
Localized sources lie in atrial regions shown mechanistically to sustain AF in optical mapping and clinical studies of human AF, as well as computational and animal studies.  ...  Pulmonary vein isolation (PVI) is central to ablation approaches for atrial fibrillation (AF), yet many patients still have arrhythmia recurrence after one or more procedures despite the latest technology  ...  (C) Right atrial rotor shown in index procedure (left) and 3 months later (right). Figure 1 . 1 Initiating mechanisms for human atrial fibrillation. (A) Electrograms of ectopy (S2) initiating AF.  ... 
doi:10.1016/j.repc.2017.09.007 pmid:29126896 pmcid:PMC5845822 fatcat:fgoujc4xbjdtxi56cuw6zpzg7i

Computational mapping in atrial fibrillation: how the integration of signal-derived maps may guide the localization of critical sources

Flavia Ravelli, Michela Masè
2014 Europace  
This article discusses the latest development in computational mapping for the identification and localization of critical sources in patients with atrial fibrillation (AF).  ...  Finally, we present a novel methodological framework, based on the construction of the logic operation map, designed to merge in a single map the most relevant electrophysiological and anatomical features  ...  Introduction Despite remarkable progress in catheter ablation of atrial fibrillation (AF), the optimal ablation strategy for persistent AF patients remains to be defined.  ... 
doi:10.1093/europace/eut376 pmid:24798961 fatcat:i2imjiibczht5lzu2xfhnfaeoq

Critical appraisal of technologies to assess electrical activity during atrial fibrillation: a position paper from the European Heart Rhythm Association and European Society of Cardiology Working Group on eCardiology in collaboration with the Heart Rhythm Society, Asia Pacific Heart Rhythm Society, Latin American Heart Rhythm Society and Computing in Cardiology

Natasja M S de Groot, Dipen Shah, Patrick M Boyle, Elad Anter, Gari D Clifford, Isabel Deisenhofer, Thomas Deneke, Pascal van Dessel, Olaf Doessel, Polychronis Dilaveris, Frank R Heinzel, Suraj Kapa (+23 others)
2021 Europace  
Discussion of (i) differences in uni-, bi-, and multi-polar (omnipolar/Laplacian) recording modes, (ii) impact of recording technologies on EGM morphology, (iii) global or local mapping using various types  ...  We aim to provide a critical appraisal of basic concepts underlying signal recording and processing technologies applied for (i) atrial fibrillation (AF) mapping to unravel AF mechanisms and/or identifying  ...  outcome • Recommendation of the optimal ablation strategy AF, atrial fibrillation; CIED, cardiac implantable electronic device; ECG, electrocardiograms; EGM, electrograms; ML, machine learning.  ... 
doi:10.1093/europace/euab254 pmid:34878119 fatcat:vkthdtuchzg43ds3ndfe5f2tm4

Benefits of Atrial Substrate Modification Guided by Electrogram Similarity and Phase Mapping Techniques to Eliminate Rotors and Focal Sources Versus Conventional Defragmentation in Persistent Atrial Fibrillation

Yenn-Jiang Lin, Men-Tzung Lo, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Tze-Fan Chao, Fa-Po Chung, Jo-Nan Liao, Chin-Yu Lin, Huan-Yu Kuo, Yi-Chung Chang, Chen Lin (+7 others)
2016 JACC Clinical Electrophysiology  
BACKGROUND The optimal ablation strategy for persistent atrial fibrillation (AF) was unknown.  ...  34) received complex fractionated atrial electrogram ablation with commercially available software.  ...  However, the benefit of adjunctive complex fractionated atrial electrograms (CFAEs) or linear ablation after successful pulmonary vein isolation (PVI) is controversial based on recent data from the STAR  ... 
doi:10.1016/j.jacep.2016.08.005 pmid:29759744 fatcat:isiarrcvzzebvfmt6w4t7rvzam

Novel approaches to mechanism-based atrial fibrillation ablation

Jorge G Quintanilla, Shlomo Shpun, José Jalife, David Filgueiras-Rama
2021 Cardiovascular Research  
Here, we review state-of-the-art technologies and provide a comprehensive historical perspective, characterization, classification, and expected outcomes of current mechanistically based methods for AF  ...  Modern cardiac electrophysiology has reported significant advances in the understanding of mechanisms underlying complex wave propagation patterns during atrial fibrillation (AF), although disagreements  ...  complex fractionated atrial electrograms (CFAEs) may be critical for maintaining AF and their ablation might result in better clinical outcomes.  ... 
doi:10.1093/cvr/cvab108 pmid:33744913 pmcid:PMC8208747 fatcat:bkdiikmwbfda7mejbrzmw7u4gq

Mechanisms of Atrial Fibrillation and Their Impact on Strategies for Catheter Ablation

Norbert Guettler, Edward Nicol, Joern Schmitt, Kim Rajappan, Internal Medicine and Cardiology, German Air Force Center for Aerospace Medicine, Fuerstenfeldbruck, Germany, Central Military Hospital, Koblenz, Germany, Department of Cardiology, Royal Brompton Hospital, London, UK, Department of Cardiology, University Hospital Giessen, Giessen, Germany, Cardiac Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
2018 European Journal of Arrhythmia & Electrophysiology  
Atrial fibrillation (AF) is the most common sustained arrhythmia, and is ubiquitous in clinical practice.  ...  Based on diverse models for the initiation and maintenance of AF, various ablation strategies have been proposed. The cornerstone of AF ablation has been pulmonary vein isolation (PVI).  ...  CFAE ablation has minimal effect on patient outcomes, but can increase procedure times and complication rates. 32 The influence of autonomic nervous system and ganglionated plexi on atrial fibrillation  ... 
doi:10.17925/ejae.2018.4.2.56 fatcat:4jnezktnrfhcjh7ug5ncgjtwnm

16th Atrial Fibrillation Symposium

Stephanie Wasek
2017 Arrhythmia & Electrophysiology Review  
The Atrial Fibrillation Practical Sessions were conducted on the first day and focused on all aspects of the AF ablation procedure and the practical usage of new technologies in the field of AF ablation  ...  in the field of AF and its treatment by catheter ablation.  ...  Most importantly, the human atrial perforation force differed from those in porcine hearts: 38 g in the RA and 63 g in the LA, even in healthy human atrial tissue. 36 Studies on the incidence of steam  ... 
doi:10.15420/aer.2017.6.4.sup1 fatcat:vzzuhwje6jbyhkxahc3rw6fpea

Challenges Associated with Interpreting Mechanisms of AF

Caroline H Roney, Andrew L Wit, Nicholas S Peters, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK, Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, NY, US, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK, National Heart and Lung Institute, Imperial College London, London, UK
2020 Arrhythmia & Electrophysiology Review  
Determining optimal treatment strategies for complex arrhythmogenesis in AF is confounded by the lack of consensus regarding the mechanisms causing AF.  ...  They explain and review different data challenges, including differences between recording devices in spatial and temporal resolutions, spatial coverage and recording surface, and report clinical outcomes  ...  The Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial -Star AF II Study (Star AF II) found no improvement in ablation outcome with the addition of linear ablation or CFAE ablation  ... 
doi:10.15420/aer.2019.08 pmid:32685158 pmcid:PMC7358959 fatcat:4cpemy76qbc2bhncxltqycmcl4

Catheter Ablation for Atrial Fibrillation

M. D. O'Neill, P. Jais, M. Hocini, F. Sacher, G. J. Klein, J. Clementy, M. Haissaguerre
2007 Circulation  
On the other hand, there is limited knowledge of how to identify, map, and ablate the culprit atrial substrate in an individual patient, because AF is generally associated with locally complex electrograms  ...  automaticity and/or local reentry, is consistent with a dominant role for the LA in human AF.  ... 
doi:10.1161/circulationaha.106.655738 pmid:17893287 fatcat:vefqo7uaubfflmlfrnhpkapsvy

Complexity of Atrial Fibrillation Electrograms Through Nonlinear Signal Analysis: In Silico Approach [chapter]

Catalina Tobón, Andrés Orozco‐Duque, Juan P. Ugarte, Miguel Becerra, Javier Saiz
2017 Interpreting Cardiac Electrograms - From Skin to Endocardium  
Identification of atrial fibrillation (AF) mechanisms could improve the rate of ablation success.  ...  This work is focused on the importance of EGM analysis for detecting and modulating rotors to guide ablation procedures and improve its outcomes.  ...  Impact of type of atrial fibrillation and repeat catheter ablation on long-term freedom from atrial fibrillation: Results from a multicenter study.  ... 
doi:10.5772/intechopen.69475 fatcat:iajkabfuvnehrlsaosrnsewnpq

Analytical approaches for myocardial fibrillation signals

Balvinder S. Handa, Caroline H. Roney, Charles Houston, Norman A. Qureshi, Xinyang Li, David S. Pitcher, Rasheda A. Chowdhury, Phang Boon Lim, Emmanuel Dupont, Steven A. Niederer, Chris D. Cantwell, Nicholas S. Peters (+1 others)
2018 Computers in Biology and Medicine  
Other techniques focus on mapping the underlying myocardial substrate sustaining fibrillation, such as voltage mapping and complex fractionated electrogram mapping.  ...  Atrial and ventricular fibrillation are complex arrhythmias, and their underlying mechanisms remain widely debated and incompletely understood.  ...  Rolf et al described a novel individualized approach, where catheter ablation of AF based on low-voltage areas in the left atrium improved clinical outcomes (65) .  ... 
doi:10.1016/j.compbiomed.2018.07.008 pmid:30025847 pmcid:PMC6215772 fatcat:tsz62t7p5fctbiku3ciwagwcvm

Is There Still a Role for Complex Fractionated Atrial Electrogram Ablation in Addition to Pulmonary Vein Isolation in Patients With Paroxysmal and Persistent Atrial Fibrillation?

Rui Providência, Pier D. Lambiase, Neil Srinivasan, Girish Ganesh Babu, Konstantinos Bronis, Syed Ahsan, Fakhar Z. Khan, Anthony W. Chow, Edward Rowland, Martin Lowe, Oliver R. Segal
2015 Circulation: Arrhythmia and Electrophysiology  
Background-Ablation of complex fractionated atrial electrograms (CFAEs) has been proposed as a strategy to improve outcomes in atrial fibrillation (AF) catheter ablation, but the use of this technique  ...  Additional ablation of CFAEs resulted in no improvement in mid-term procedural outcome or freedom from AF or atrial tachycardia (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.58-1.10; P=0.17).  ...  WHAT IS KNOWN • Complex fractionated atrial electrograms (CFAEs) have emerged as one of the possible sources for sustaining atrial fibrillation, and CFAE ablation has become a widespread adjuvant strategy  ... 
doi:10.1161/circep.115.003019 pmid:26082515 fatcat:vybnnscjpvfp5gsbx2j6f5xkmm
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