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- W4380680439 abstract "Introduction: A clinical spectrum exists for atrial tachyarrhythmias, wherein tachycardia (AT) often responds to ablation, some patients with atrial fibrillation (AF) respond well to ablation, and others do not. It is undefined if this clinical spectrum can be predicted pathophysiologically. Hypothesis: We hypothesize that the size of regions within which electrograms (EGMs) show repeating shapes also synchronized in time reveals a spectrum from AT, to AF patients who respond acutely to ablation, to AF patients without acute response. Methods: We studied N=160 patients (35% women, 65.0±10.4Y) of whom (i) N=150 were AF patients propensity-matched for those whose AF terminated by ablation (N=75; “Term”) and those which did not (N=75; “Non-term”); (ii) N=10 with AT. All patients had mapping by 64 pole baskets to identify areas of repetitive electrical activity in shape and timing (REACT, range 0 to 1), by correlating unipolar electrograms (EGMs) in 2x2 grids iteratively across the atria (Fig A&B). Results: Synchronized regions (REACT) fell from AT to AF Term to AF Non-term (0.63±0.15, 0.37±0.22, 0.22±0.18, p<0.001, Fig C&D). On ROC analysis, AUC for predicting AF termination was 0.70 ([0.61, 0.78] 95% CI). Simulations revealed a nomogram in which increasing REACT represented increasing variability in clinical EGM shape and timing. Unsupervised machine learning of REACT plus 50 variables yielded 4 clusters of increasing risk for AF termination (p<0.01, chi-sq) but clinical profiles alone were less predictive (p<0.001). Conclusions: The area of synchronized EGM shape and timing within the atrium reveals a spectrum of clinical response in atrial tachyarrhythmias. These fundamental EGM properties, which do not reflect any specific mechanism or mapping technology, predict outcome and offer a platform to compare mapping tools and mechanisms between AF patient groups." @default.
- W4380680439 created "2023-06-15" @default.
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- W4380680439 date "2022-11-08" @default.
- W4380680439 modified "2023-09-25" @default.
- W4380680439 title "Abstract 11304: Spectrum of Clinical Response in Atrial Tachyarrhythmias Identified by Spatiotemporal Synchronization of Electrograms" @default.
- W4380680439 doi "https://doi.org/10.1161/circ.146.suppl_1.11304" @default.
- W4380680439 hasPublicationYear "2022" @default.
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