Can mapping and ablation of atrial fibrillation be guided by frequency analysis of fibrillatory waves?

Conventional atrial fibrillation (AF) mapping is limited by the interpretation of the varied and complex time-domain signals throughout the atria. Frequency-domain signals provide a feasible method to analyze the temporal and regional distribution of atrial activation during AF. This helps us learn more about the mechanisms of AF. The maintenance of AF, whether paroxysmal or persistent, depends on rapid activities in part of the atrium. These AF sources activate atria at very high frequencies and result in fibrillatory conductions. This article focuses on the regional frequency distribution and the spectral morphology in different types of AF. In patients with paroxysmal AF from pulmonary veins, the highest frequency drivers are located around the arrhythmogenic vein with a left atrium (LA)-to-right atrium (RA) frequency gradient. Conversely, in patients with paroxysmal AF from superior vena cava and persistent AF, the LA-to-RA frequency gradient may not be evident. As the figure demonstrates, the ablation strategy guided by frequency analysis may be a better way for finding the critical substrate for the maintenance of AF.