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Comparative Study
. 2007 Oct;12(4):329-37.
doi: 10.1111/j.1542-474X.2007.00182.x.

Noninvasive assessment of atrial substrate change after wide area circumferential ablation: a comparison with segmental pulmonary vein isolation

Damian P Redfearn  1 , Allan C Skanes, Lorne J Gula, Michael J Griffith, Howard J Marshall, Peter J Stafford, Andrew D Krahn, Raymond Yee, George J Klein
Affiliations
Comparative Study

Noninvasive assessment of atrial substrate change after wide area circumferential ablation: a comparison with segmental pulmonary vein isolation

Damian P Redfearn et al. Ann Noninvasive Electrocardiol. 2007 Oct.

Abstract

Background: The wide area circumferential ablation (WACA) approach to atrial fibrillation is thought to result in 'substrate modification' perhaps related to autonomic denervation. We examined this prospectively by comparing WACA and segmental pulmonary vein isolation (PVI) using noninvasive surrogate markers.

Methods: Heart rate variability (HRV) and signal averaged P wave (SAPW) data were derived from high-resolution (HR) recordings ('SpiderView' ELA Medical) made in sinus rhythm immediately before and 24 hours after ablation.

Results: Forty patients recruited (20 WACA; 20 PVI); cohorts were comparable. WACA caused marked SAPW change: P wave duration (PWD) (149[4.6] ms to 160[5.9] ms; P = 0.003), root mean square (RMS) (4.4[0.4]microV to 2.8[0.4]; P = 0.001) and energy content (30-150 Hz; 20.4 [3.6]microV(2)/s to 13.7[2.4]; P = 0.001). No significant change was seen after PVI. Heart rate increased after WACA and PVI (61.4 to 73.5 [P = 0.001]; 69.5 to 75.0 [P = 0.07], respectively). HRV was significantly influenced after WACA: low frequency power (LF) 5.7(0.4) to 3.6(0.4); P = 0.001), high-frequency power (HF) 4.6(0.4)-3.4(0.3); P = 0.024, and after PVI: LF 5.4(0.3) to 4.3(0.3); P = 0.024. HF: 4.4(0.4) to 3.0(0.4); P = 0.018).

Conclusions: HR recordings exhibit change in HRV after WACA and PVI. Marked change in both HRV and SAPW is observed after WACA. SAPW variables provide a measure of atrial substrate change after WACA unrelated to autonomic denervation.

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Figures

Figure 1
Figure 1
Registered 64 slice CT using CARTO. A lesion arrangement is shown with ablation lines circling the right and left pulmonary veins separately. A roof line joins both circles.
Figure 2
Figure 2
Representative sample of time domain and frequency domain results before and after wide area circumferential ablation as depicted in Fig. 1. The left panel shows the filtered P wave before and after ablation, respectively, above the corresponding frequency domain analysis. P wave duration increases and overall magnitude decreases after ablation. This is quantified in the frequency domain (below). The power within the spectrum can be seen to be reduced after ablation. This is quantified into energy bands: P30 represents 30–150 Hz; P60 represents higher frequencies between 60 and 150 Hz. The time domain X‐axis is in micro volts (μV); each large square represents 50 ms on the Y‐axis. The frequency domain X‐axis represents frequency in Hertz (Hz); the Y‐axis is in micro volts squared (μV2).
See this image and copyright information in PMC

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