Autocorrelation function for predicting arrhythmic recurrences in patients undergoing persistent atrial fibrillation ablation

Raquel Cervigón1, Eduardo Franco2, Cristina Lozano2, Javier Moreno2
1UCLM, 2Hospital Ramón y Cajal


Abstract

Persistent atrial fibrillation (PAF) ablation has a high recurrence rate. We performed an analysis of bipolar intracavitary signals obtained with a conventional 24-pole diagnostic catheter (Woven Orbiter) placed in the right atrium (RA) and coronary sinus (CS) in a cohort of patients with persistent atrial fibrillation undergoing ablation to detect features predictive of acute procedural success (conversion to sinus rhythm during ablation) and the occurrence of recurrences. In a cohort of consecutive patients with PAF undergoing pulmonary vein ablation + drivers (regions with continuous electrical activity and regions with spatio-temporal dispersion + fragmentation), recordings were obtained from the Orbiter catheter at baseline (before ablation) during AF. For each dipole, its autocorrelation function was analysed, comparing consecutive electrograms and establishing the degree of similarity between. 31 patients included (61±10 years, 77 %male; left atrial index volume 38±17ml/m2; 10 with previous ablations). Ablation achieved reversion to sinus rhythm in 12 patients (39%). After a mean follow-up of 15±8 months, 10 patients (32%) had arrhythmic recurrence, excluding 3-month blanking. In 2 patients, the length of electrograms recorded was insufficient (discarded). High RA and SC ostium electrograms of patients with reversion to sinus rhythm during ablation showed a higher correlation between the amplitude of successive electrograms (more similar voltage), and a lower frequency (greater distance between relative amplitude maxima), with no significant differences due to the small sample size. The same behavior was observed in patients without arrhythmic recurrences with respect to those with recurrences. There were no relevant differences in left atrial (coronary sinus) electrograms. Greater similarity in the voltage of successive electrograms and lower frequency in the electrical activity recorded at high RA and CS ostium may be associated with a greater likelihood of achieving reversion to sinus rhythm and lower probability of recurrences. A larger study is needed to draw conclusions.