Department of Engineering, University of Leicester, University Road, Leicester, England, LE1 7RH, UK.
Engineering, Modelling and Applied Social Sciences Centre, Federal ABC University, Santo André, Brazil.
Med Biol Eng Comput. 2018 Jan;56(1):71-83. doi: 10.1007/s11517-017-1667-1. Epub 2017 Jul 3.
The unstable temporal behavior of atrial electrical activity during persistent atrial fibrillation (persAF) might influence ablation target identification, which could explain the conflicting persAF ablation outcomes in previous studies. We sought to investigate the temporal behavior and consistency of atrial electrogram (AEG) fractionation using different segment lengths. Seven hundred ninety-seven bipolar AEGs were collected with three segment lengths (2.5, 5,and 8 s) from 18 patients undergoing persAF ablation. The AEGs with 8-s duration were divided into three 2.5-s consecutive segments. AEG fractionation classification was applied off-line to all cases following the CARTO criteria; 43% of the AEGs remained fractionated for the three consecutive AEG segments, while nearly 30% were temporally unstable. AEG classification within the consecutive segments had moderate correlation (segment 1 vs 2: Spearman's correlation ρ = 0.74, kappa score κ = 0.62; segment 1 vs 3: ρ = 0.726, κ = 0.62; segment 2 vs 3: ρ = 0.75, κ = 0.68). AEG classifications were more similar between AEGs with 5 and 8 s (ρ = 0.96, κ = 0.87) than 2.5 versus 5 s (ρ = 0.93, κ = 0.84) and 2.5 versus 8 s (ρ = 0.90, κ = 0.78). Our results show that the CARTO criteria should be revisited and consider recording duration longer than 2.5 s for consistent ablation target identification in persAF.
持续性心房颤动（persAF）期间心房电活动的不稳定时间行为可能会影响消融靶点的识别，这可以解释先前研究中相互矛盾的 persAF 消融结果。我们试图研究使用不同节段长度时心房电图（AEG）碎裂的时间行为和一致性。我们从 18 名接受 persAF 消融的患者中收集了 797 个双极 AEG，使用 3 个节段长度（2.5、5 和 8 s）。8 s 时长的 AEG 被分为 3 个连续的 2.5 s 节段。所有病例均按照 CARTO 标准离线应用 AEG 碎裂分类；在三个连续的 AEG 节段中，有 43%的 AEG 仍然存在碎裂，而近 30%的 AEG 时间不稳定。连续节段内的 AEG 分类具有中度相关性（节段 1 与 2：Spearman 相关系数 ρ=0.74，kappa 评分 κ=0.62；节段 1 与 3：ρ=0.726，κ=0.62；节段 2 与 3：ρ=0.75，κ=0.68）。AEG 节段长度为 5 和 8 s 时的分类更相似（ρ=0.96，κ=0.87），而 2.5 s 与 5 s（ρ=0.93，κ=0.84）和 2.5 s 与 8 s（ρ=0.90，κ=0.78）相比。我们的结果表明，CARTO 标准应进行重新审查，并考虑记录时间超过 2.5 s，以在 persAF 中实现一致的消融靶点识别。
