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; Ta Chuan Tuan; Hsu Wen Vincent Young; Kazuyoshi Suenari; Van Buu Dan Do; Suunu Budhi Raharjo; Norden E. Huang; Shih Ann Chen

doi:10.1016/j.jacep.2016.08.005

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, Ta Chuan Tuan, Hsu Wen Vincent Young, Kazuyoshi Suenari, Van Buu Dan Do, Suunu Budhi Raharjo, Norden E. Huang, Shih Ann Chen

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Objectives This prospective study compared the efficacy of atrial substrate modification guided by a nonlinear phase mapping technique with that of conventional substrate ablation. Background The optimal ablation strategy for persistent atrial fibrillation (AF) was unknown. Methods In phase 1 study, we applied a cellular automation technique to simulate the electrical wave propagation to improve the phase mapping algorithm, involving analysis of high-similarity electrogram regions. In addition, we defined rotors and focal AF sources, using the physical parameters of the divergence and curvature forces. In phase 2 study, we enrolled 68 patients with persistent AF undergoing substrate modification into 2 groups, group-1 (n = 34) underwent similarity index (SI) and phase mapping techniques; group-2 (n = 34) received complex fractionated atrial electrogram ablation with commercially available software. Group-1 received real-time waveform similarity measurements in which a phase mapping algorithm was applied to localize the sources. We evaluated the single-procedure freedom from AF. Results In group-1, we identified an average of 2.6 ± 0.89 SI regions per chamber. These regions involved rotors and focal sources in 65% and 77% of patients in group-1, respectively. Group-1 patients had shorter ablation procedure times, higher termination rates, and significant reduction in AF recurrence compared to group-2 and a trend toward benefit for all atrial arrhythmias. Multivariate analysis showed that substrate mapping using nonlinear similarity and phase mapping was the independent predictor of freedom from AF recurrence (hazard ratio: 0.26; 95% confidence interval: 0.09 to 0.74; p = 0.01). Conclusions Our study showed that for persistent AF ablation, a specified substrate modification guided by nonlinear phase mapping could eliminate localized re-entry and non-pulmonary focal sources after pulmonary vein isolation.

Original language	English
Pages (from-to)	667-678
Number of pages	12
Journal	JACC: Clinical Electrophysiology
Volume	2
Issue number	6
DOIs	https://doi.org/10.1016/j.jacep.2016.08.005
State	Published - 1 Nov 2016

Keywords

ablation
atrial fibrillation
electrogram
rotor

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Lin, Y. J., Lo, M. T., Chang, S. L., Lo, L. W., Hu, Y. F., Chao, T. F., Chung, F. P., Liao, J. N., Lin, C. Y., Kuo, H. Y., Chang, Y. C., Lin, C., Tuan, T. C., Vincent Young, H. W., Suenari, K., Dan Do, V. B., Raharjo, S. B., Huang, N. E., & Chen, S. A. (2016). 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. JACC: Clinical Electrophysiology, 2(6), 667-678. https://doi.org/10.1016/j.jacep.2016.08.005

@article{5adeba08c49b478785dc80331b50a83b,

title = "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",

abstract = "Objectives This prospective study compared the efficacy of atrial substrate modification guided by a nonlinear phase mapping technique with that of conventional substrate ablation. Background The optimal ablation strategy for persistent atrial fibrillation (AF) was unknown. Methods In phase 1 study, we applied a cellular automation technique to simulate the electrical wave propagation to improve the phase mapping algorithm, involving analysis of high-similarity electrogram regions. In addition, we defined rotors and focal AF sources, using the physical parameters of the divergence and curvature forces. In phase 2 study, we enrolled 68 patients with persistent AF undergoing substrate modification into 2 groups, group-1 (n = 34) underwent similarity index (SI) and phase mapping techniques; group-2 (n = 34) received complex fractionated atrial electrogram ablation with commercially available software. Group-1 received real-time waveform similarity measurements in which a phase mapping algorithm was applied to localize the sources. We evaluated the single-procedure freedom from AF. Results In group-1, we identified an average of 2.6 ± 0.89 SI regions per chamber. These regions involved rotors and focal sources in 65% and 77% of patients in group-1, respectively. Group-1 patients had shorter ablation procedure times, higher termination rates, and significant reduction in AF recurrence compared to group-2 and a trend toward benefit for all atrial arrhythmias. Multivariate analysis showed that substrate mapping using nonlinear similarity and phase mapping was the independent predictor of freedom from AF recurrence (hazard ratio: 0.26; 95% confidence interval: 0.09 to 0.74; p = 0.01). Conclusions Our study showed that for persistent AF ablation, a specified substrate modification guided by nonlinear phase mapping could eliminate localized re-entry and non-pulmonary focal sources after pulmonary vein isolation.",

keywords = "ablation, atrial fibrillation, electrogram, rotor",

author = "Lin, {Yenn Jiang} and Lo, {Men Tzung} and Chang, {Shih Lin} and Lo, {Li Wei} and Hu, {Yu Feng} and Chao, {Tze Fan} and Chung, {Fa Po} and Liao, {Jo Nan} and Lin, {Chin Yu} and Kuo, {Huan Yu} and Chang, {Yi Chung} and Chen Lin and Tuan, {Ta Chuan} and {Vincent Young}, {Hsu Wen} and Kazuyoshi Suenari and {Dan Do}, {Van Buu} and Raharjo, {Suunu Budhi} and Huang, {Norden E.} and Chen, {Shih Ann}",

note = "Publisher Copyright: {\textcopyright} 2016 American College of Cardiology Foundation",

year = "2016",

month = nov,

day = "1",

doi = "10.1016/j.jacep.2016.08.005",

language = "English",

volume = "2",

pages = "667--678",

journal = "JACC: Clinical Electrophysiology",

issn = "2405-500X",

publisher = "Elsevier USA",

number = "6",

}

Lin, YJ, Lo, MT, Chang, SL , Lo, LW , Hu, YF, Chao, TF, Chung, FP, Liao, JN, Lin, CY, Kuo, HY, Chang, YC, Lin, C, Tuan, TC, Vincent Young, HW, Suenari, K, Dan Do, VB, Raharjo, SB, Huang, NE & Chen, SA 2016, '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', JACC: Clinical Electrophysiology, vol. 2, no. 6, pp. 667-678. https://doi.org/10.1016/j.jacep.2016.08.005

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. / Lin, Yenn Jiang; Lo, Men Tzung; Chang, Shih Lin et al.
In: JACC: Clinical Electrophysiology, Vol. 2, No. 6, 01.11.2016, p. 667-678.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - 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

AU - Lin, Yenn Jiang

AU - Lo, Men Tzung

AU - Chang, Shih Lin

AU - Lo, Li Wei

AU - Hu, Yu Feng

AU - Chao, Tze Fan

AU - Chung, Fa Po

AU - Liao, Jo Nan

AU - Lin, Chin Yu

AU - Kuo, Huan Yu

AU - Chang, Yi Chung

AU - Lin, Chen

AU - Tuan, Ta Chuan

AU - Vincent Young, Hsu Wen

AU - Suenari, Kazuyoshi

AU - Dan Do, Van Buu

AU - Raharjo, Suunu Budhi

AU - Huang, Norden E.

AU - Chen, Shih Ann

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Objectives This prospective study compared the efficacy of atrial substrate modification guided by a nonlinear phase mapping technique with that of conventional substrate ablation. Background The optimal ablation strategy for persistent atrial fibrillation (AF) was unknown. Methods In phase 1 study, we applied a cellular automation technique to simulate the electrical wave propagation to improve the phase mapping algorithm, involving analysis of high-similarity electrogram regions. In addition, we defined rotors and focal AF sources, using the physical parameters of the divergence and curvature forces. In phase 2 study, we enrolled 68 patients with persistent AF undergoing substrate modification into 2 groups, group-1 (n = 34) underwent similarity index (SI) and phase mapping techniques; group-2 (n = 34) received complex fractionated atrial electrogram ablation with commercially available software. Group-1 received real-time waveform similarity measurements in which a phase mapping algorithm was applied to localize the sources. We evaluated the single-procedure freedom from AF. Results In group-1, we identified an average of 2.6 ± 0.89 SI regions per chamber. These regions involved rotors and focal sources in 65% and 77% of patients in group-1, respectively. Group-1 patients had shorter ablation procedure times, higher termination rates, and significant reduction in AF recurrence compared to group-2 and a trend toward benefit for all atrial arrhythmias. Multivariate analysis showed that substrate mapping using nonlinear similarity and phase mapping was the independent predictor of freedom from AF recurrence (hazard ratio: 0.26; 95% confidence interval: 0.09 to 0.74; p = 0.01). Conclusions Our study showed that for persistent AF ablation, a specified substrate modification guided by nonlinear phase mapping could eliminate localized re-entry and non-pulmonary focal sources after pulmonary vein isolation.

AB - Objectives This prospective study compared the efficacy of atrial substrate modification guided by a nonlinear phase mapping technique with that of conventional substrate ablation. Background The optimal ablation strategy for persistent atrial fibrillation (AF) was unknown. Methods In phase 1 study, we applied a cellular automation technique to simulate the electrical wave propagation to improve the phase mapping algorithm, involving analysis of high-similarity electrogram regions. In addition, we defined rotors and focal AF sources, using the physical parameters of the divergence and curvature forces. In phase 2 study, we enrolled 68 patients with persistent AF undergoing substrate modification into 2 groups, group-1 (n = 34) underwent similarity index (SI) and phase mapping techniques; group-2 (n = 34) received complex fractionated atrial electrogram ablation with commercially available software. Group-1 received real-time waveform similarity measurements in which a phase mapping algorithm was applied to localize the sources. We evaluated the single-procedure freedom from AF. Results In group-1, we identified an average of 2.6 ± 0.89 SI regions per chamber. These regions involved rotors and focal sources in 65% and 77% of patients in group-1, respectively. Group-1 patients had shorter ablation procedure times, higher termination rates, and significant reduction in AF recurrence compared to group-2 and a trend toward benefit for all atrial arrhythmias. Multivariate analysis showed that substrate mapping using nonlinear similarity and phase mapping was the independent predictor of freedom from AF recurrence (hazard ratio: 0.26; 95% confidence interval: 0.09 to 0.74; p = 0.01). Conclusions Our study showed that for persistent AF ablation, a specified substrate modification guided by nonlinear phase mapping could eliminate localized re-entry and non-pulmonary focal sources after pulmonary vein isolation.

KW - ablation

KW - atrial fibrillation

KW - electrogram

KW - rotor

UR - http://www.scopus.com/inward/record.url?scp=84994791959&partnerID=8YFLogxK

U2 - 10.1016/j.jacep.2016.08.005

DO - 10.1016/j.jacep.2016.08.005

M3 - Article

AN - SCOPUS:84994791959

SN - 2405-500X

VL - 2

SP - 667

EP - 678

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

IS - 6

ER -

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

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