Please use this identifier to cite or link to this item:
Title: Atrial electrogram fractionation distribution before and after pulmonary vein isolation in human persistent atrial fibrillation – a retrospective multivariate statistical analysis
Authors: Almeida, Tiago P.
Chu, Gavin S.
Li, Xin
Dastagir, Nawshin
Tuan, Jiun H.
Stafford, Peter J.
Schlindwein, Fernando S.
Ng, G. Andre
First Published: 31-Jul-2017
Publisher: Frontiers Media
Citation: Frontiers in Physiology, 2017, 8:589
Abstract: Purpose – Complex fractionated atrial electrograms (CFAE)-guided ablation after pulmonary vein isolation (PVI) has been used for persistent atrial fibrillation (persAF) therapy. This strategy, however, has shown suboptimal outcomes due to, among other factors, undetected changes in the atrial tissue following PVI. In the present work, we investigate CFAE distribution before and after PVI in patients with persAF using a multivariate statistical model. Methods – 207 pairs of atrial electrograms (AEGs) were collected before and after PVI respectively, from corresponding LA regions in 18 persAF patients. Twelve attributes were measured from the AEGs, before and after PVI. Statistical models based on multivariate analysis of variance (MANOVA) and linear discriminant analysis (LDA) have been used to characterize the atrial regions and AEGs. Results – PVI significantly reduced CFAEs in the LA (70% vs. 40%; P<0.0001). Four types of LA regions were identified, based on the AEGs characteristics: (i) fractionated before PVI that remained fractionated after PVI (31% of the collected points); (ii) fractionated that converted to normal (39%); (iii) normal prior to PVI that became fractionated (9%) and; (iv) normal that remained normal (21%). Individually, the attributes failed to distinguish these LA regions, but multivariate statistical models were effective in their discrimination (P<0.0001). Conclusion – Our results have unveiled that there are LA regions resistant to PVI, while others are affected by it. Although traditional methods were unable to identify these different regions, the proposed multivariate statistical model discriminated LA regions resistant to PVI from those affected by it without prior ablation information.
DOI Link: 10.3389/fphys.2017.00589
eISSN: 1664-042X
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © the authors, 2017. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Appears in Collections:Published Articles, Dept. of Engineering

Files in This Item:
File Description SizeFormat 
fphys-08-00589.pdfPublished (publisher PDF)4.02 MBAdobe PDFView/Open

Items in LRA are protected by copyright, with all rights reserved, unless otherwise indicated.