Catheter ablation for Atrial fibrillation: Electrogram-guided methods [Ablación cardiaca auricular: estrategias guiadas por el mapeo de electrogramas]
Radiofrequency catheter ablation has evolved into an effective treatment option for drug-resistant patients with atrial fibrillation. Electrical isolation of the pulmonary veins has become the standard ablation strategy mainly in patients with paroxysmal atrial fibrillation. However, the success rat...
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- Tipo de recurso:
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- 2018
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- Universidad de Medellín
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- Repositorio UDEM
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Catheter ablation for Atrial fibrillation: Electrogram-guided methods [Ablación cardiaca auricular: estrategias guiadas por el mapeo de electrogramas] |
| title |
Catheter ablation for Atrial fibrillation: Electrogram-guided methods [Ablación cardiaca auricular: estrategias guiadas por el mapeo de electrogramas] |
| spellingShingle |
Catheter ablation for Atrial fibrillation: Electrogram-guided methods [Ablación cardiaca auricular: estrategias guiadas por el mapeo de electrogramas] |
| title_short |
Catheter ablation for Atrial fibrillation: Electrogram-guided methods [Ablación cardiaca auricular: estrategias guiadas por el mapeo de electrogramas] |
| title_full |
Catheter ablation for Atrial fibrillation: Electrogram-guided methods [Ablación cardiaca auricular: estrategias guiadas por el mapeo de electrogramas] |
| title_fullStr |
Catheter ablation for Atrial fibrillation: Electrogram-guided methods [Ablación cardiaca auricular: estrategias guiadas por el mapeo de electrogramas] |
| title_full_unstemmed |
Catheter ablation for Atrial fibrillation: Electrogram-guided methods [Ablación cardiaca auricular: estrategias guiadas por el mapeo de electrogramas] |
| title_sort |
Catheter ablation for Atrial fibrillation: Electrogram-guided methods [Ablación cardiaca auricular: estrategias guiadas por el mapeo de electrogramas] |
| description |
Radiofrequency catheter ablation has evolved into an effective treatment option for drug-resistant patients with atrial fibrillation. Electrical isolation of the pulmonary veins has become the standard ablation strategy mainly in patients with paroxysmal atrial fibrillation. However, the success rate of pulmonary veins isolation is about 50% in patients with persistent atrial fibrillation. Although different strategies to guide the electrophysiologist in ablation procedures have been proposed. Recent studies show that the generation of additional ablation lines guided anatomically or by fragmented complex electrograms mapping does not improve the success rate of the conventional pulmonary veins isolation procedure. In this review, we describe the limitations of current electrophysiological mapping methods, the new electrogram evaluation strategies and the signal processing methods that are proposed in the immediate future, to guide ablation procedures, particularly in patients with atrial fibrillation persistent. © 2018 Sociedad Mexicana de Ingenieria Biomedica. All rights reserved. |
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2018 |
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2021-02-05T14:59:51Z |
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2021-02-05T14:59:51Z |
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2018 |
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1889532 |
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http://hdl.handle.net/11407/6126 |
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10.17488/RMIB.39.3.1 |
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1889532 10.17488/RMIB.39.3.1 |
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http://hdl.handle.net/11407/6126 |
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Camm, A.J., Kirchhof, P., Gyh, L., Schotten, U., Savelieva, I., Ernst, S., Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Eur Heart J [Internet] 2010 [Cited 2014 Jan 21], 31 (19), pp. 2369-2429. , http://www.ncbi.nlm.nih.gov/pubmed/20802247 Cantú, C., True Hills, M., Massaro, A., Goto, S., Hu, H.-H., Quek, D.K., (2012) Atrial Fibrillation-Related Stroke Across Latin America : A Preventable Problem Working Group Recommendations Atrial Fibrillation-Related Stroke Across Latin America : A Preventable Problem Working Group Recommendations January, C.T., Wann, L.S., Alpert, J.S., Calkins, H., Cigarroa, J.E., Cleveland, J.C., AHA/ACC/HRS Guideline for the Management of Patients with Atrial Fibrillation (2014) J Am Coll Cardiol [Internet] 2014, 64 (21), pp. e1-e76. , https://www.sciencedirect.com/science/article/pii/S0735109714017409?via%3Dihub Calkins, H., Kuck, K.H., Cappato, R., Chen, J.A., Camm, B.J., HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: A re (2012) Heart Rhythm [Internet] 2012 [Cited 2014 Jan 22], 9 (4), pp. 632-696. , http://www.ncbi.nlm.nih.gov/pubmed/22386883, e21 Roten, L., Derval, N., Jaïs, P., Catheter ablation for persistent atrial fibrillation: Elimination of triggers is not sufficient Circ Arrhythm Electrophysiol [Internet] 2012 [Cited 2014 Nov 3], 5 (6), pp. 1224-1232. , https://goo.gl/mG1Fhm, discussion 1232 Cappato, R., Calkins, H., Chen, S.-A., Davies, W., Iesaka, Y., Kalman, J., Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation (2010) Circ Arrhythmia Electrophysiol, 3 (1), pp. 32-38 Brooks, A.G., Stiles, M.K., Laborderie, J., Lau, D.H., Kuklik, P., Shipp, N.J., Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review (2010) Hear Rhythm, 7 (6), pp. 835-846 Arbelo, E., Brugada, J., Hindricks, G., Maggioni, A.P., Tavazzi, L., Vardas, P., The Atrial Fibrillation Ablation Pilot Study: An European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association (2014) Eur Heart J, 35 (22), pp. 1466-1478 Mathew, S.T., Patel, J., Joseph, S., Atrial fibrillation: Mechanistic insights and treatment options Eur J Intern Med [Internet] 2009 [Cited 2014 Nov 3], 20 (7), pp. 672-681. , http://www.ncbi.nlm.nih.gov/pubmed/19818285 Yaksh, A., Kik, C., Knops, P., Roos-Hesselink, J.W., Jjc, B., Zijlstra, F., Atrial fibrillation: To map or not to map? (2014) Netherlands Hear J [Internet], 22 (6), pp. 259-266. , http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4031356&tool=pmcentrez&rendertype=abstract Narayan, S.M., Krummen, D.E., Enyeart, M.W., Rappel, W.J., Computational Mapping Identifies Localized Mechanisms for Ablation of Atrial Fibrillation (2012) PLoS One, 7, p. 9 Chang, S.-L., Chen, Y.-C., Hsu, C.-P., Kao, Y.-H., Lin, Y.-K., Lin, Y.-J., Electrophysiological characteristics of complex fractionated electrograms and high frequency activity in atrial fibrillation (2013) Int J Cardiol [Internet], 168 (3), pp. 2289-2299. , http://www.ncbi.nlm.nih.gov/pubmed/23465221, [cited 2014 Nov 3] Ganesan, A.N., Kuklik, P., Lau, D.H., Brooks, A.G., Baumert, M., Lim, W.W., Bipolar electrogram shannon entropy at sites of rotational activation: Implications for ablation of atrial fibrillation (2013) Circ Arrhythmia Electrophysiol, 6 (1), pp. 48-57 Ugarte, J.P., Tobón, C., Orozco-Duque, A., Ma, B., Bustamante, J., Effect of the electrograms density in detecting and ablating the tip of the rotor during chronic atrial fibrillation: An in silico study (2015) EP Europace, 17. , (Issue suppl-2): ii97-ii104 Verma, A., Jiang, C., Betts, T., Chen, J., Deisenhofer, I., Mantovan, R., Approaches to Catheter Ablation for Persistent Atrial Fibrillation (2015) N Engl J Med, 372, pp. 1812-1822 Berenfeld, O., Jalife, J., Complex Fractionated Atrail Electrograms Is this the Beast to Tame in AF (2011) Circ Arrhythm Electrophysiol, 4 (4), pp. 426-428 Almeida, T.P., Jr., Chu, G.S., Ng, G.A., Schlindwein, F.S., Sciences, C., Different Definitions of Complex Fractionated Atrial Electrograms do not Concur with the Clinical Perspective (2013) Comput Cardiol 2010, 40, pp. 1055-1058 Ciaccio, E.J., Biviano, A.B., Whang, W., Garan, H., Identification of recurring patterns in fractionated atrial electrograms using new transform coefficients Biomed Eng Online [Internet] 2012 [Cited 2012 May 4], 11 (1), p. 4. , http://www.biomedical-engineering-online.com/content/11/1/4 Eitel, C., Hindricks, G., Dagres, N., Sommer, P., Piorkowski, C., EnSite Velocity cardiac mapping system: A new platform for 3D mapping of cardiac arrhythmias (2010) Expert Rev Med Devices [Internet], 7 (2), pp. 185-192. , http://www.ncbi.nlm.nih.gov/pubmed/20214424 Rolf, S., Hindricks, G., Sommer, P., Richter, S., Arya, A., Kosiuk, J., Electroanatomical mapping of atrial fibrillation : review of the current techniques and advances (2015) J Atr Fibrillation, 7, p. 4 Haissaguerre, M., Jais, P., Shah, D.C., Takahashi, A., Hocini, M., Quiniou, G., Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins (1998) N Engl J Med, 339 (10), pp. 659-666 Jalife, J., Berenfeld, O., Mansour, M., Mother rotors and fibrillatory conduction: A mechanism of atrial fibrillation (2002) Cardiovasc. Res, 54 (2), pp. 204-216 Kalifa, J., Tanaka, K., Zaitsev, A.V., Warren, M., Vaidyanathan, R., Auerbach, D., Mechanisms of wave fractionation at boundaries of high-frequency excitation in the posterior left atrium of the isolated sheep heart during atrial fibrillation (2006) Circulation, 113 (5), pp. 626-633 Umapathy, K., Masse, S., Kolodziejska, K., Veenhuyzen, G.D., Chauhan, V.S., Husain, M., Electrogram fractionation in murine HL-1 atrial monolayer model (2008) Heart Rhythm, 5 (7), pp. 1029-1035 Narayan, S.M., Patel, J., Mulpuru, S., Krummen, D.E., Focal impulse and rotor modulation ablation of sustaining rotors abruptly terminates persistent atrial fibrillation to sinus rhythm with elimination on follow-up: A video case study (2012) Hear Rhythm, 9 (9), pp. 1436-1439 Allessie, M.A., De Groot, N.M.S., Houben, R.P.M., Schotten, U., Boersma, E., Smeets, J.L., Electropathological substrate of long-standing persistent atrial fibrillation in patients with structural heart disease longitudinal dissociation (2010) Circ Arrhythmia Electrophysiol, 3 (6), pp. 606-615 Lee, G., Kumar, S., Teh, A., Madry, A., Spence, S., Larobina, M., Epicardial wave mapping in human long-lasting persistent atrial fibrillation: Transient rotational circuits, complex wavefronts, and disorganized activity (2014) Eur Heart J, 35 (2), pp. 86-97 Van Marion, D.M.S., Lanters, E.A.H., Wiersma, M., Allessie, M.A., Brundel, B.B.J.J.M., De Groot, N.M.S., Diagnosis and therapy of atrial fibrillation: The past the present and the future (2015) J Atr Fibrillation, 8 (2), p. 1216 Allessie, M., De Groot, N., CrossTalk opposing view: Rotors have not been demonstrated to be the drivers of atrial fibrillation (2014) J Physiol, 592 (15), pp. 3167-3170 Clarnette, J.A., Brooks, A.G., Mahajan, R., Outcomes of persistent and long-standing persistent atrial fibrillation ablation: A systematic review and meta-Analysis (2017) EP Eur [Internet], pp. 1-11. , https://goo.gl/mnZMZ2, February Nademanee, K., McKenzie, J., Kosar, E., Schwab, M., Sunsaneewitayakul, B., Vasavakul, T., A new approach for catheter ablation of atrial fibrillation: Mapping of the electrophysiologic substrate (2004) J Am Coll Cardiol, 43 (11), pp. 2044-2053 Oral, H., Chugh, A., Good, E., Wimmer, A., Dey, S., Gadeela, N., Radiofrequency catheter ablation of chronic atrial fibrillation guided by complex electrograms (2007) Circulation, 115 (20), pp. 2606-2612 Chen, J., Lin, Y., Chen, L., Yu, J., Du, Z., Li, S., A decade of complex fractionated electrograms catheter-based ablation for atrial fibrillation: Literature analysis, meta-Analysis and systematic review (2014) IJC Hear Vessel, 4 (1), pp. 63-72 Narayan, S.M., Shivkumar, K., Krummen, D.E., Miller, J.M., Rappel, W.J., Panoramic electrophysiological mapping but not electrogram morphology identifies stable sources for human atrial fibrillation: Stable atrial fibrillation rotors and focal sources relate poorly to fractionated electrograms (2013) Circ Arrhythmia Electrophysiol, 6 (1), pp. 58-67 Verma, A., Jiang, C., Betts, T.R., Chen, J., Deisenhofer, I., Mantovan, R., Approaches to Catheter Ablation for Persistent Atrial Fibrillation (2015) N Engl J Med, 372 (19), pp. 1812-1822 Kirchhof, P., Calkins, H., Clinical update Catheter ablation in patients with persistent atrial fibrillation (2017) Eur Heart J, 38, pp. 20-26 Reddy, V.Y., Atrial fibrillation: Unanswered questions and future directions Cardiol Clin [Internet] 2009 [Cited 2012 May 8], 27 (1), pp. 201-216. , http://linkinghub.elsevier.com/retrieve/pii/S0733865108001069 Elayi, C.S., Verma, A., Di Biase, L., Ching, C.K., Patel, D., Barrett, C., Ablation for longstanding permanent atrial fibrillation: Results from a randomized study comparing three different strategies (2008) Hear Rhythm, 5 (12), pp. 1658-1664 Magnani, S., Muser, D., Chik, W., Santangeli, P., Adjunct ablation strategies for persistent atrial fibrillation-beyond pulmonary vein isolation (2015) J. Thorac. Dis, 7 (2), pp. 178-184 Chen, J., Lin, Y., Chen, L., Yu, J., Du, Z., Li, S., A decade of complex fractionated electrograms catheter-based ablation for atrial fibrillation: Literature analysis meta-Analysis and systematic review (2014) IJC Hear Vessel [Internet], , http://linkinghub.elsevier.com/retrieve/pii/S2214763214000522, [cited 2014 Nov 3];1-10 Oketani, N., Seitz, J., Salazar, M., Pisapia, A., Ablation of complex fractionated electrograms is useful for catheter ablation of persistent atrial fi brillation : Protagonist point of view (2016) Hear Rhythm [Internet], 13 (10), pp. 2098-2100. , http://dx.doi.org/10.1016/j.hrthm.2016.06.036 Jadidi, A.S., Lehrmann, H., Keyl, C., Sorrel, J., Markstein, V., Minners, J., Ablation of persistent atrial fibrillation targeting low-voltage areas with selective activation characteristics (2016) Circ Arrhythm Electrophysiol, 9 (3), p. e002962 Vogler, J., Willems, S., Sultan, A., Schreiber, D., Löker, J., Servatius, H., Pulmonary vein isolation versus defragmentation the chase-Af clinical trial (2015) J Am Coll Cardiol, 66 (24), pp. 2743-2752 Narayan, S.M., Baykaner, T., Clopton, P., Schricker, A., Lalani, G.G., Krummen, D.E., Ablation of rotor and focal sources reduces late recurrence of atrial fibrillation compared with trigger ablation alone: Extended follow-up of the CONFIRM trial conventional ablation for atrial fibrillation with or without focal impulse and rotor modulat (2014) J Am Coll Cardiol, 63 (17), pp. 1761-1768 Narayan, S.M., Krummen, D.E., Shivkumar, K., Clopton, P., Rappel, W.-J., Miller, J.M., Treatment of atrial fibrillation by the ablation of localized sources (2012) J Am Coll Cardiol [Internet], 60 (7), pp. 628-636 Haissaguerre, M., Hocini, M., Denis, A., Shah, A.J., Komatsu, Y., Yamashita, S., Driver domains in persistent atrial fibrillation (2014) Circulation, 130 (7), pp. 530-538 Buch, E., Share, M., Tung, R., Benharash, P., Sharma, P., Koneru, J., Long-Term clinical outcomes of focal impulse and rotor modulation for treatment of atrial fibrillation: A multicenter experience (2016) Hear Rhythm, 13 (3), pp. 636-641 Ravelli, F., Masè, M., Cristoforetti, A., Marini, M., Disertori, M., The logical operator map identifies novel candidate markers for critical sites in patients with atrial fibrillation (2014) Prog Biophys Mol Biol, 115 (2-3), pp. 186-197 Sanders, P., Nalliah, C.J., Dubois, R., Takahashi, Y., Hocini, M., Rotter, M., Frequency mapping of the pulmonary veins in paroxysmal versus permanent atrial fibrillation (2006) J Cardiovasc Electrophysiol, 17 (9), pp. 965-972 Novák, D., Kremen, V., Cuesta, D., Schmidt, K., Chudácek, V., Lhotská, L., Discrimination of endocardial electrogram disorganization using a signal regularity analysis (2009) Conf Proc IEEE Eng Med Biol Soc [Internet], 2009, pp. 1812-1815. , http://www.ncbi.nlm.nih.gov/pubmed/19963768 Jalife, J., Rotors and spiral waves in atrial fibrillation (2003) J Cardiovasc Electrophysiol, 14 (7), pp. 776-780 Botteron, G.W., Smith, J.M., A technique for measurement of the extent of spatial organization of atrial activation during atrial fibrillation in the intact human heart (1995) IEEE Trans Biomed Eng, 42 (6), pp. 579-586 Sanders, P., Berenfeld, O., Hocini, M., Jais, P., Vaidyanathan, R., Hsu, L.F., Spectral analysis identifies sites of high-frequency activity maintaining atrial fibrillation in humans (2005) Circulation, 112 (6), pp. 789-797 Everett, I.V.T.H., Kok, L.C., Vaughn, R.H., Moorman, J.R., De, H., Frequency domain algorithm for quantifying atrial fibrillation organization to increase defibrillation efficacy (2001) IEEE Trans Biomed Eng, 48 (9), pp. 969-978 Ng, J., Kadish, A.H., Goldberger, J.J., Technical considerations for dominant frequency analysis (2007) J Cardiovasc Electrophysiol, 18 (7), pp. 757-764 Elvan, A., Linnenbank, A.C., Van Bemmel, M.W., Arr, M., Pphm, D., Beukema, W.P., Dominant frequency of atrial fibrillation correlates poorly with atrial fibrillation cycle length (2009) Circ Arrhythmia Electrophysiol, 2 (6), pp. 634-644 Houben, R.P.M., De Groot, N.M.S., Allessie, M.A., Analysis of fractionated atrial fibrillation electrograms by wavelet decomposition (2010) IEEE Trans Biomed Eng [Internet], 57 (6), pp. 1388-1398. , http://www.ncbi.nlm.nih.gov/pubmed/20142164 Kremen, V., Lhotská, L., Macas, M., Cihák, R., Vancura, V., Kautzner, J., A new approach to automated assessment of fractionation of endocardial electrograms during atrial fibrillation Physiol Meas [Internet] 2008 [Cited 2014 Feb 26], 29 (12), pp. 1371-1381. , http://www.ncbi.nlm.nih.gov/pubmed/18946155 Ng, J., Borodyanskiy, A.I., Chang, E.T., Villuendas, R., Dibs, S., Kadish, A.H., Measuring the complexity of atrial fibrillation electrograms (2010) J Cardiovasc Electrophysiol, 21 (6), pp. 649-655 Navoret, N., Jacquir, S., Laurent, G., Binczak, S., Detection of complex fractionated atrial electrograms using recurrence quantification analysis (2013) IEEE Trans Biomed Eng, 60 (7), pp. 1975-1982 Ganesan, A.N., Kuklik, P., Lau, D.H., Brooks, A.G., Baumert, M., Lim, W.W., Bipolar electrogram Shannon entropy at sites of rotational activation implications for ablation of atrial fibrillation (2013) Circ Arrhythmia Electrophysiol, 6 (1), pp. 48-57 Ugarte, J., Orozco-Duque, A., Tobón, C., Kremen, V., Novak, D., Saiz, J., Dynamic approximate entropy electroanatomic maps detect rotors in a simulated atrial fibrillation model (2014) PLoS One, 9 (12), p. e114577 Cuesta-Frau, A.D., Cirugeda-Roldan, E., Pico, A.M., Novak, D., María, E., Roldán, C., Atrial electrogram complex fractionated entropy study (2014) Exp Clin Cardiol, 20 (9), pp. 5566-5574 Orozco-Duque, A., Novak, D., Kremen, V., Bustamante, J., Multifractal analysis for grading complex fractionated electrograms in atrial fibrillation (2015) Physiol Meas [Internet], 36 (11), pp. 2269-2284. , http://stacks.iop.org/0967-3334/36/i=11/a=2269?key=crossref.e7d25ed6d37af12d3473767bace5c3ea Urda-Benitez, R.D., Castro-Ospina, A., Orozco-Duque, A., Feature extraction based on time-singularity multifractal spectrum distribution in intracardiac atrial fibrillation signals Distribución tiempo singularidad del (2017) TecnolLgicas, 20 (40), pp. 97-111 Kremen, V., (2008) Automated Assessment of Endocardial Electrograms Fractionation in Human Schilling, C., Keller, M., Scherr, D., Oesterlein, T., Haïssaguerre, M., Schmitt, C., Fuzzy decision tree to classify complex fractionated atrial electrograms (2015) Biomed Tech (Berl) [Internet], , http://www.ncbi.nlm.nih.gov/pubmed/25781659, [cited 2015 Mar 26] Wells, J., Karp, R., Kouchoukos, N., Maclean, W., James, T., Waldo, A., Characterization of Atrial Fibrillation in Man: Studies Following Open Heart Surgery (1978) Pacing Clin Electrophysiol, 1 (4), pp. 426-438 Schilling, C., Keller, M., Scherr, D., Oesterlein, T., Haïssaguerre, M., Schmitt, C., Fuzzy decision tree to classify complex fractionated atrial electrograms (2015) Biomed Tech, 60 (3), pp. 245-255 Křemen, V., Lhotská, L., Macaš, M., Čihák, R., Vančura, V., Kautzner, J., A new approach to automated assessment of fractionation of endocardial electrograms during atrial fibrillation (2008) Physiol Meas, 29 (12), pp. 1371-1381 Hunter, R.J., Diab, I., Thomas, G., Duncan, E., Abrams, D., Dhinoja, M., Validation of a classification system to grade fractionation in atrial fibrillation and correlation with automated detection systems (2009) Europace, 11 (12), pp. 1587-1596 Nollo, G., Marconcini, M., Faes, L., Bovolo, F., Ravelli, F., Bruzzone, L., An automatic system for the analysis and classification of human atrial fibrillation patterns from intracardiac electrograms (2008) IEEE Trans Biomed Eng, 55 (9), pp. 2275-2285 Duque, S.I., Orozco-Duque, A., Kremen, V., Novak, D., Tobón, C., Bustamante, J., Feature subset selection and classification of intracardiac electrograms during atrial fibrillation (2017) Biomed Signal Process Control [Internet], 38, pp. 182-190. , http://dx.doi.org/10.1016/j.bspc.2017.06.005 Orozco-Duque, A., Bustamante, J., Castellanos-Dominguez, G., Semi-supervised clustering of fractionated electrograms for electroanatomical atrial mapping (2016) Biomed Eng Online, 15 (1), p. 44 |
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Facultad de Ciencias Básicas |
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Sociedad Mexicana de Ingenieria Biomedica |
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20182021-02-05T14:59:51Z2021-02-05T14:59:51Z1889532http://hdl.handle.net/11407/612610.17488/RMIB.39.3.1Radiofrequency catheter ablation has evolved into an effective treatment option for drug-resistant patients with atrial fibrillation. Electrical isolation of the pulmonary veins has become the standard ablation strategy mainly in patients with paroxysmal atrial fibrillation. However, the success rate of pulmonary veins isolation is about 50% in patients with persistent atrial fibrillation. Although different strategies to guide the electrophysiologist in ablation procedures have been proposed. Recent studies show that the generation of additional ablation lines guided anatomically or by fragmented complex electrograms mapping does not improve the success rate of the conventional pulmonary veins isolation procedure. In this review, we describe the limitations of current electrophysiological mapping methods, the new electrogram evaluation strategies and the signal processing methods that are proposed in the immediate future, to guide ablation procedures, particularly in patients with atrial fibrillation persistent. © 2018 Sociedad Mexicana de Ingenieria Biomedica. All rights reserved.spaSociedad Mexicana de Ingenieria BiomedicaFacultad de Ciencias Básicashttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85054586996&doi=10.17488%2fRMIB.39.3.1&partnerID=40&md5=b9dcffe4278a09f871b20656790c5bdb393208224Camm, A.J., Kirchhof, P., Gyh, L., Schotten, U., Savelieva, I., Ernst, S., Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Eur Heart J [Internet] 2010 [Cited 2014 Jan 21], 31 (19), pp. 2369-2429. , http://www.ncbi.nlm.nih.gov/pubmed/20802247Cantú, C., True Hills, M., Massaro, A., Goto, S., Hu, H.-H., Quek, D.K., (2012) Atrial Fibrillation-Related Stroke Across Latin America : A Preventable Problem Working Group Recommendations Atrial Fibrillation-Related Stroke Across Latin America : A Preventable Problem Working Group RecommendationsJanuary, C.T., Wann, L.S., Alpert, J.S., Calkins, H., Cigarroa, J.E., Cleveland, J.C., AHA/ACC/HRS Guideline for the Management of Patients with Atrial Fibrillation (2014) J Am Coll Cardiol [Internet] 2014, 64 (21), pp. e1-e76. , https://www.sciencedirect.com/science/article/pii/S0735109714017409?via%3DihubCalkins, H., Kuck, K.H., Cappato, R., Chen, J.A., Camm, B.J., HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: A re (2012) Heart Rhythm [Internet] 2012 [Cited 2014 Jan 22], 9 (4), pp. 632-696. , http://www.ncbi.nlm.nih.gov/pubmed/22386883, e21Roten, L., Derval, N., Jaïs, P., Catheter ablation for persistent atrial fibrillation: Elimination of triggers is not sufficient Circ Arrhythm Electrophysiol [Internet] 2012 [Cited 2014 Nov 3], 5 (6), pp. 1224-1232. , https://goo.gl/mG1Fhm, discussion 1232Cappato, R., Calkins, H., Chen, S.-A., Davies, W., Iesaka, Y., Kalman, J., Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation (2010) Circ Arrhythmia Electrophysiol, 3 (1), pp. 32-38Brooks, A.G., Stiles, M.K., Laborderie, J., Lau, D.H., Kuklik, P., Shipp, N.J., Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review (2010) Hear Rhythm, 7 (6), pp. 835-846Arbelo, E., Brugada, J., Hindricks, G., Maggioni, A.P., Tavazzi, L., Vardas, P., The Atrial Fibrillation Ablation Pilot Study: An European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association (2014) Eur Heart J, 35 (22), pp. 1466-1478Mathew, S.T., Patel, J., Joseph, S., Atrial fibrillation: Mechanistic insights and treatment options Eur J Intern Med [Internet] 2009 [Cited 2014 Nov 3], 20 (7), pp. 672-681. , http://www.ncbi.nlm.nih.gov/pubmed/19818285Yaksh, A., Kik, C., Knops, P., Roos-Hesselink, J.W., Jjc, B., Zijlstra, F., Atrial fibrillation: To map or not to map? (2014) Netherlands Hear J [Internet], 22 (6), pp. 259-266. , http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4031356&tool=pmcentrez&rendertype=abstractNarayan, S.M., Krummen, D.E., Enyeart, M.W., Rappel, W.J., Computational Mapping Identifies Localized Mechanisms for Ablation of Atrial Fibrillation (2012) PLoS One, 7, p. 9Chang, S.-L., Chen, Y.-C., Hsu, C.-P., Kao, Y.-H., Lin, Y.-K., Lin, Y.-J., Electrophysiological characteristics of complex fractionated electrograms and high frequency activity in atrial fibrillation (2013) Int J Cardiol [Internet], 168 (3), pp. 2289-2299. , http://www.ncbi.nlm.nih.gov/pubmed/23465221, [cited 2014 Nov 3]Ganesan, A.N., Kuklik, P., Lau, D.H., Brooks, A.G., Baumert, M., Lim, W.W., Bipolar electrogram shannon entropy at sites of rotational activation: Implications for ablation of atrial fibrillation (2013) Circ Arrhythmia Electrophysiol, 6 (1), pp. 48-57Ugarte, J.P., Tobón, C., Orozco-Duque, A., Ma, B., Bustamante, J., Effect of the electrograms density in detecting and ablating the tip of the rotor during chronic atrial fibrillation: An in silico study (2015) EP Europace, 17. , (Issue suppl-2): ii97-ii104Verma, A., Jiang, C., Betts, T., Chen, J., Deisenhofer, I., Mantovan, R., Approaches to Catheter Ablation for Persistent Atrial Fibrillation (2015) N Engl J Med, 372, pp. 1812-1822Berenfeld, O., Jalife, J., Complex Fractionated Atrail Electrograms Is this the Beast to Tame in AF (2011) Circ Arrhythm Electrophysiol, 4 (4), pp. 426-428Almeida, T.P., Jr., Chu, G.S., Ng, G.A., Schlindwein, F.S., Sciences, C., Different Definitions of Complex Fractionated Atrial Electrograms do not Concur with the Clinical Perspective (2013) Comput Cardiol 2010, 40, pp. 1055-1058Ciaccio, E.J., Biviano, A.B., Whang, W., Garan, H., Identification of recurring patterns in fractionated atrial electrograms using new transform coefficients Biomed Eng Online [Internet] 2012 [Cited 2012 May 4], 11 (1), p. 4. , http://www.biomedical-engineering-online.com/content/11/1/4Eitel, C., Hindricks, G., Dagres, N., Sommer, P., Piorkowski, C., EnSite Velocity cardiac mapping system: A new platform for 3D mapping of cardiac arrhythmias (2010) Expert Rev Med Devices [Internet], 7 (2), pp. 185-192. , http://www.ncbi.nlm.nih.gov/pubmed/20214424Rolf, S., Hindricks, G., Sommer, P., Richter, S., Arya, A., Kosiuk, J., Electroanatomical mapping of atrial fibrillation : review of the current techniques and advances (2015) J Atr Fibrillation, 7, p. 4Haissaguerre, M., Jais, P., Shah, D.C., Takahashi, A., Hocini, M., Quiniou, G., Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins (1998) N Engl J Med, 339 (10), pp. 659-666Jalife, J., Berenfeld, O., Mansour, M., Mother rotors and fibrillatory conduction: A mechanism of atrial fibrillation (2002) Cardiovasc. Res, 54 (2), pp. 204-216Kalifa, J., Tanaka, K., Zaitsev, A.V., Warren, M., Vaidyanathan, R., Auerbach, D., Mechanisms of wave fractionation at boundaries of high-frequency excitation in the posterior left atrium of the isolated sheep heart during atrial fibrillation (2006) Circulation, 113 (5), pp. 626-633Umapathy, K., Masse, S., Kolodziejska, K., Veenhuyzen, G.D., Chauhan, V.S., Husain, M., Electrogram fractionation in murine HL-1 atrial monolayer model (2008) Heart Rhythm, 5 (7), pp. 1029-1035Narayan, S.M., Patel, J., Mulpuru, S., Krummen, D.E., Focal impulse and rotor modulation ablation of sustaining rotors abruptly terminates persistent atrial fibrillation to sinus rhythm with elimination on follow-up: A video case study (2012) Hear Rhythm, 9 (9), pp. 1436-1439Allessie, M.A., De Groot, N.M.S., Houben, R.P.M., Schotten, U., Boersma, E., Smeets, J.L., Electropathological substrate of long-standing persistent atrial fibrillation in patients with structural heart disease longitudinal dissociation (2010) Circ Arrhythmia Electrophysiol, 3 (6), pp. 606-615Lee, G., Kumar, S., Teh, A., Madry, A., Spence, S., Larobina, M., Epicardial wave mapping in human long-lasting persistent atrial fibrillation: Transient rotational circuits, complex wavefronts, and disorganized activity (2014) Eur Heart J, 35 (2), pp. 86-97Van Marion, D.M.S., Lanters, E.A.H., Wiersma, M., Allessie, M.A., Brundel, B.B.J.J.M., De Groot, N.M.S., Diagnosis and therapy of atrial fibrillation: The past the present and the future (2015) J Atr Fibrillation, 8 (2), p. 1216Allessie, M., De Groot, N., CrossTalk opposing view: Rotors have not been demonstrated to be the drivers of atrial fibrillation (2014) J Physiol, 592 (15), pp. 3167-3170Clarnette, J.A., Brooks, A.G., Mahajan, R., Outcomes of persistent and long-standing persistent atrial fibrillation ablation: A systematic review and meta-Analysis (2017) EP Eur [Internet], pp. 1-11. , https://goo.gl/mnZMZ2, FebruaryNademanee, K., McKenzie, J., Kosar, E., Schwab, M., Sunsaneewitayakul, B., Vasavakul, T., A new approach for catheter ablation of atrial fibrillation: Mapping of the electrophysiologic substrate (2004) J Am Coll Cardiol, 43 (11), pp. 2044-2053Oral, H., Chugh, A., Good, E., Wimmer, A., Dey, S., Gadeela, N., Radiofrequency catheter ablation of chronic atrial fibrillation guided by complex electrograms (2007) Circulation, 115 (20), pp. 2606-2612Chen, J., Lin, Y., Chen, L., Yu, J., Du, Z., Li, S., A decade of complex fractionated electrograms catheter-based ablation for atrial fibrillation: Literature analysis, meta-Analysis and systematic review (2014) IJC Hear Vessel, 4 (1), pp. 63-72Narayan, S.M., Shivkumar, K., Krummen, D.E., Miller, J.M., Rappel, W.J., Panoramic electrophysiological mapping but not electrogram morphology identifies stable sources for human atrial fibrillation: Stable atrial fibrillation rotors and focal sources relate poorly to fractionated electrograms (2013) Circ Arrhythmia Electrophysiol, 6 (1), pp. 58-67Verma, A., Jiang, C., Betts, T.R., Chen, J., Deisenhofer, I., Mantovan, R., Approaches to Catheter Ablation for Persistent Atrial Fibrillation (2015) N Engl J Med, 372 (19), pp. 1812-1822Kirchhof, P., Calkins, H., Clinical update Catheter ablation in patients with persistent atrial fibrillation (2017) Eur Heart J, 38, pp. 20-26Reddy, V.Y., Atrial fibrillation: Unanswered questions and future directions Cardiol Clin [Internet] 2009 [Cited 2012 May 8], 27 (1), pp. 201-216. , http://linkinghub.elsevier.com/retrieve/pii/S0733865108001069Elayi, C.S., Verma, A., Di Biase, L., Ching, C.K., Patel, D., Barrett, C., Ablation for longstanding permanent atrial fibrillation: Results from a randomized study comparing three different strategies (2008) Hear Rhythm, 5 (12), pp. 1658-1664Magnani, S., Muser, D., Chik, W., Santangeli, P., Adjunct ablation strategies for persistent atrial fibrillation-beyond pulmonary vein isolation (2015) J. Thorac. Dis, 7 (2), pp. 178-184Chen, J., Lin, Y., Chen, L., Yu, J., Du, Z., Li, S., A decade of complex fractionated electrograms catheter-based ablation for atrial fibrillation: Literature analysis meta-Analysis and systematic review (2014) IJC Hear Vessel [Internet], , http://linkinghub.elsevier.com/retrieve/pii/S2214763214000522, [cited 2014 Nov 3];1-10Oketani, N., Seitz, J., Salazar, M., Pisapia, A., Ablation of complex fractionated electrograms is useful for catheter ablation of persistent atrial fi brillation : Protagonist point of view (2016) Hear Rhythm [Internet], 13 (10), pp. 2098-2100. , http://dx.doi.org/10.1016/j.hrthm.2016.06.036Jadidi, A.S., Lehrmann, H., Keyl, C., Sorrel, J., Markstein, V., Minners, J., Ablation of persistent atrial fibrillation targeting low-voltage areas with selective activation characteristics (2016) Circ Arrhythm Electrophysiol, 9 (3), p. e002962Vogler, J., Willems, S., Sultan, A., Schreiber, D., Löker, J., Servatius, H., Pulmonary vein isolation versus defragmentation the chase-Af clinical trial (2015) J Am Coll Cardiol, 66 (24), pp. 2743-2752Narayan, S.M., Baykaner, T., Clopton, P., Schricker, A., Lalani, G.G., Krummen, D.E., Ablation of rotor and focal sources reduces late recurrence of atrial fibrillation compared with trigger ablation alone: Extended follow-up of the CONFIRM trial conventional ablation for atrial fibrillation with or without focal impulse and rotor modulat (2014) J Am Coll Cardiol, 63 (17), pp. 1761-1768Narayan, S.M., Krummen, D.E., Shivkumar, K., Clopton, P., Rappel, W.-J., Miller, J.M., Treatment of atrial fibrillation by the ablation of localized sources (2012) J Am Coll Cardiol [Internet], 60 (7), pp. 628-636Haissaguerre, M., Hocini, M., Denis, A., Shah, A.J., Komatsu, Y., Yamashita, S., Driver domains in persistent atrial fibrillation (2014) Circulation, 130 (7), pp. 530-538Buch, E., Share, M., Tung, R., Benharash, P., Sharma, P., Koneru, J., Long-Term clinical outcomes of focal impulse and rotor modulation for treatment of atrial fibrillation: A multicenter experience (2016) Hear Rhythm, 13 (3), pp. 636-641Ravelli, F., Masè, M., Cristoforetti, A., Marini, M., Disertori, M., The logical operator map identifies novel candidate markers for critical sites in patients with atrial fibrillation (2014) Prog Biophys Mol Biol, 115 (2-3), pp. 186-197Sanders, P., Nalliah, C.J., Dubois, R., Takahashi, Y., Hocini, M., Rotter, M., Frequency mapping of the pulmonary veins in paroxysmal versus permanent atrial fibrillation (2006) J Cardiovasc Electrophysiol, 17 (9), pp. 965-972Novák, D., Kremen, V., Cuesta, D., Schmidt, K., Chudácek, V., Lhotská, L., Discrimination of endocardial electrogram disorganization using a signal regularity analysis (2009) Conf Proc IEEE Eng Med Biol Soc [Internet], 2009, pp. 1812-1815. , http://www.ncbi.nlm.nih.gov/pubmed/19963768Jalife, J., Rotors and spiral waves in atrial fibrillation (2003) J Cardiovasc Electrophysiol, 14 (7), pp. 776-780Botteron, G.W., Smith, J.M., A technique for measurement of the extent of spatial organization of atrial activation during atrial fibrillation in the intact human heart (1995) IEEE Trans Biomed Eng, 42 (6), pp. 579-586Sanders, P., Berenfeld, O., Hocini, M., Jais, P., Vaidyanathan, R., Hsu, L.F., Spectral analysis identifies sites of high-frequency activity maintaining atrial fibrillation in humans (2005) Circulation, 112 (6), pp. 789-797Everett, I.V.T.H., Kok, L.C., Vaughn, R.H., Moorman, J.R., De, H., Frequency domain algorithm for quantifying atrial fibrillation organization to increase defibrillation efficacy (2001) IEEE Trans Biomed Eng, 48 (9), pp. 969-978Ng, J., Kadish, A.H., Goldberger, J.J., Technical considerations for dominant frequency analysis (2007) J Cardiovasc Electrophysiol, 18 (7), pp. 757-764Elvan, A., Linnenbank, A.C., Van Bemmel, M.W., Arr, M., Pphm, D., Beukema, W.P., Dominant frequency of atrial fibrillation correlates poorly with atrial fibrillation cycle length (2009) Circ Arrhythmia Electrophysiol, 2 (6), pp. 634-644Houben, R.P.M., De Groot, N.M.S., Allessie, M.A., Analysis of fractionated atrial fibrillation electrograms by wavelet decomposition (2010) IEEE Trans Biomed Eng [Internet], 57 (6), pp. 1388-1398. , http://www.ncbi.nlm.nih.gov/pubmed/20142164Kremen, V., Lhotská, L., Macas, M., Cihák, R., Vancura, V., Kautzner, J., A new approach to automated assessment of fractionation of endocardial electrograms during atrial fibrillation Physiol Meas [Internet] 2008 [Cited 2014 Feb 26], 29 (12), pp. 1371-1381. , http://www.ncbi.nlm.nih.gov/pubmed/18946155Ng, J., Borodyanskiy, A.I., Chang, E.T., Villuendas, R., Dibs, S., Kadish, A.H., Measuring the complexity of atrial fibrillation electrograms (2010) J Cardiovasc Electrophysiol, 21 (6), pp. 649-655Navoret, N., Jacquir, S., Laurent, G., Binczak, S., Detection of complex fractionated atrial electrograms using recurrence quantification analysis (2013) IEEE Trans Biomed Eng, 60 (7), pp. 1975-1982Ganesan, A.N., Kuklik, P., Lau, D.H., Brooks, A.G., Baumert, M., Lim, W.W., Bipolar electrogram Shannon entropy at sites of rotational activation implications for ablation of atrial fibrillation (2013) Circ Arrhythmia Electrophysiol, 6 (1), pp. 48-57Ugarte, J., Orozco-Duque, A., Tobón, C., Kremen, V., Novak, D., Saiz, J., Dynamic approximate entropy electroanatomic maps detect rotors in a simulated atrial fibrillation model (2014) PLoS One, 9 (12), p. e114577Cuesta-Frau, A.D., Cirugeda-Roldan, E., Pico, A.M., Novak, D., María, E., Roldán, C., Atrial electrogram complex fractionated entropy study (2014) Exp Clin Cardiol, 20 (9), pp. 5566-5574Orozco-Duque, A., Novak, D., Kremen, V., Bustamante, J., Multifractal analysis for grading complex fractionated electrograms in atrial fibrillation (2015) Physiol Meas [Internet], 36 (11), pp. 2269-2284. , http://stacks.iop.org/0967-3334/36/i=11/a=2269?key=crossref.e7d25ed6d37af12d3473767bace5c3eaUrda-Benitez, R.D., Castro-Ospina, A., Orozco-Duque, A., Feature extraction based on time-singularity multifractal spectrum distribution in intracardiac atrial fibrillation signals Distribución tiempo singularidad del (2017) TecnolLgicas, 20 (40), pp. 97-111Kremen, V., (2008) Automated Assessment of Endocardial Electrograms Fractionation in HumanSchilling, C., Keller, M., Scherr, D., Oesterlein, T., Haïssaguerre, M., Schmitt, C., Fuzzy decision tree to classify complex fractionated atrial electrograms (2015) Biomed Tech (Berl) [Internet], , http://www.ncbi.nlm.nih.gov/pubmed/25781659, [cited 2015 Mar 26]Wells, J., Karp, R., Kouchoukos, N., Maclean, W., James, T., Waldo, A., Characterization of Atrial Fibrillation in Man: Studies Following Open Heart Surgery (1978) Pacing Clin Electrophysiol, 1 (4), pp. 426-438Schilling, C., Keller, M., Scherr, D., Oesterlein, T., Haïssaguerre, M., Schmitt, C., Fuzzy decision tree to classify complex fractionated atrial electrograms (2015) Biomed Tech, 60 (3), pp. 245-255Křemen, V., Lhotská, L., Macaš, M., Čihák, R., Vančura, V., Kautzner, J., A new approach to automated assessment of fractionation of endocardial electrograms during atrial fibrillation (2008) Physiol Meas, 29 (12), pp. 1371-1381Hunter, R.J., Diab, I., Thomas, G., Duncan, E., Abrams, D., Dhinoja, M., Validation of a classification system to grade fractionation in atrial fibrillation and correlation with automated detection systems (2009) Europace, 11 (12), pp. 1587-1596Nollo, G., Marconcini, M., Faes, L., Bovolo, F., Ravelli, F., Bruzzone, L., An automatic system for the analysis and classification of human atrial fibrillation patterns from intracardiac electrograms (2008) IEEE Trans Biomed Eng, 55 (9), pp. 2275-2285Duque, S.I., Orozco-Duque, A., Kremen, V., Novak, D., Tobón, C., Bustamante, J., Feature subset selection and classification of intracardiac electrograms during atrial fibrillation (2017) Biomed Signal Process Control [Internet], 38, pp. 182-190. , http://dx.doi.org/10.1016/j.bspc.2017.06.005Orozco-Duque, A., Bustamante, J., Castellanos-Dominguez, G., Semi-supervised clustering of fractionated electrograms for electroanatomical atrial mapping (2016) Biomed Eng Online, 15 (1), p. 44Revista Mexicana de Ingenieria BiomedicaCatheter ablation for Atrial fibrillation: Electrogram-guided methods [Ablación cardiaca auricular: estrategias guiadas por el mapeo de electrogramas]Articleinfo:eu-repo/semantics/articlehttp://purl.org/coar/version/c_970fb48d4fbd8a85http://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1Orozco-Duque, A., Grupo de Investigación e Innovación Biomédica, Instituto Tecnológico Metropolitano, Carrera 65 #98 A-75, Medellín, Antioquia, Colombia, Centro de Bioingeniería, Universidad Pontificia Bolivariana, Medellín, ColombiaMorillo, C., Cardiology Division, Libin Cardiovascular Institute, University of Calgary, Calgary, CanadaTobón, C., MATBIOM, Facultad de Ciencias Básicas, Universidad de Medellín, Medellín, ColombiaUgarte, J.P., GIMSC Facultad de Ingenierías, Universidad de San Buenaventura, Medellín, ColombiaBustamante, J., Centro de Bioingeniería, Universidad Pontificia Bolivariana, Medellín, Colombiahttp://purl.org/coar/access_right/c_16ecOrozco-Duque A.Morillo C.Tobón C.Ugarte J.P.Bustamante J.11407/6126oai:repository.udem.edu.co:11407/61262021-02-05 09:59:51.414Repositorio Institucional Universidad de Medellinrepositorio@udem.edu.co |