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The utility of combining continuous wavelet transform analysis and high-density voltage map in predicting the long-term outcomes after ablation of persistent atrial fibrillation

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Abstract

Background

Continuous wavelet transform (CWT) analysis is a frequency analysis to detect areas of stable high-frequent activity (stable pseudo frequency [sPF]) during atrial fibrillation (AF). As previously reported, patients with the highest sPF area in pulmonary veins (PV) showed better short-term outcomes after PV isolation (PVI). This study sought to evaluate the efficacy of CWT analysis in predicting the long-term (2 years) outcomes after PVI. We also combined the left atrial (LA) voltage map with CWT analysis to further predict the outcome.

Methods

Persistent AF patients (n = 109, age 65 ± 10) underwent a CWT analysis at PVs and 8 LA sites during AF for pre-PVI analysis. After PVI during AF, CWT analysis was performed again in the LA as post-PVI analysis and was compared with pre-PVI analysis. A sinus voltage map of LA was created after cardioversion.

Results

Seventy patients had the highest sPF within PVs (PV-dominant group), while 39 patients had the highest sPF outside PVs (LA-dominant group). The global frequency in the LA showed a significant decrease after PVI only in PV-dominant group (6.55 ± 0.27 to 6.43 ± 0.37, P < 0.01). AF-free survival was better in PV-dominant group than LA-dominant group at 2-year follow-up (87.1% vs. 64.3%, P < 0.002). This trend was recognized throughout all degrees of low voltage area in the LA (LA-LVA), and AF-free survival was well predicted by combining CWT analysis and LA-LVA.

Conclusions

By combining CWT analysis and sinus LA-LVA, the long-term AF-free survival after PVI was well stratified and predicted.

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Abbreviations

PV:

Pulmonary vein

PVI:

Pulmonary vein isolation

AF:

Atrial fibrillation

LA:

Left atrium

LVA:

Low voltage area

FFT:

Fast Fourier Transform

CWT:

Continuous wavelet transform

EGM:

Electrogram

PF:

Pseudo frequency

CV:

Coefficient of variation

sPF:

Stable pseudo frequency

LSPV:

Left superior pulmonary vein

LIPV:

Left inferior pulmonary vein

RSPV:

Right superior pulmonary vein

RIPV:

Right inferior pulmonary vein

LCPV:

Left common pulmonary vein

RCPV:

Right common pulmonary vein

LAA:

Left atrial appendage

DC:

Direct current

RAA:

Right atrial appendage

CTI:

Cavo-tricuspid isthmus

AT:

Atrial tachycardia

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Authors and Affiliations

  1. Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake Hiratsuka, Kanagawa, Japan

    Koji Higuchi, Shinsuke Iwai, Nobutaka Kato, Hirotaka Muramoto & Yuko Onishi

  2. Department of Cardiology, St. Luke’s International Hospital, Tokyo, Japan

    Yasuhiro Yokoyama

  3. Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan

    Kenzo Hirao & Tetsuo Sasano

Authors
  1. Koji Higuchi
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  2. Shinsuke Iwai
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Correspondence to Koji Higuchi.

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Ethical approval

This study was approved by ethical committee of Hiratsuka Kyosai Hospital.

Conflict of interest

The software for CWT analysis was provided by Nihon Kohden Medical Company. Dr. Higuchi received lecture honoraria from Biosense Webster, Abbott. Inc., Medtronic, and Biotronik.

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Higuchi, K., Iwai, S., Kato, N. et al. The utility of combining continuous wavelet transform analysis and high-density voltage map in predicting the long-term outcomes after ablation of persistent atrial fibrillation. J Interv Card Electrophysiol 66, 405–416 (2023). https://doi.org/10.1007/s10840-022-01337-3

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