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Characteristics of atrial fibrillation cycle length predict restoration of sinus rhythm by catheter ablation

Di Marco, Luigi Yuri; Raine, Daniel; Bourke, John P.; Langley, Philip


Luigi Yuri Di Marco

Daniel Raine

John P. Bourke


Background Successful termination of atrial fibrillation (AF) during catheter ablation (CA) is associated with arrhythmia-free follow-up. Preablation factors such as mean atrial fibrillation cycle length (AFCL) predict the likelihood of AF termination during ablation but recurring patterns and AFCL stability have not been evaluated. Objective To investigate novel predictors of acute and postoperative ablation outcomes from intracardiac electrograms: (1) recurring AFCL patterns and (2) localization index (LI) of the instantaneous fibrillatory rate distribution. Methods Sixty-two patients with AF (32 paroxysmal AF; 45 men; age 57 ± 10 years) referred for CA were enrolled. One-minute electrogram was recorded from coronary sinus (CS; 5 bipoles) and right atrial appendage (HRA; 2 bipoles). Atrial activations were detected automatically to derive the AFCL and instantaneous fibrillatory rate (inverse of AFCL) time series. Recurring AFCL patterns were quantified by using recurrence plot indices (RPIs): percentage determinism, entropy of determinism, and maximum diagonal length. AFCL stability was determined by using the LI. The CA outcome predictivity of individual indices was assessed. Results Patients with terminated atrial fibrillation (T-AF) had higher RPI (P < .05 in CS 7-8 ) and LI than did those with nonterminated atrial fibrillation (P < .005 in CS 3-4 ; P < .05 in CS 5-6 , CS 7-8 , and HRA). Patients free of arrhythmia after 3-month follow-up had higher RPI and LI (all P < .05 in CS 7-8 ). All indices except percentage determinism predicted T-AF in CS 7-8 (area under the curve [AUC] ≥ 0.71; odds ratio [OR] ≥ 4.50; P < .05). The median AFCL and LI predicted T-AF in HRA D (AUC ≥ 0.75; OR ≥ 7.76; P < .05). The RPI and LI predicted 3-month follow-up in CS 7-8 (AUC ≥ 0.68; OR ≥ 4.17; P < .05). Conclusions AFCL recurrence and stability indices could be used in selecting patients more likely to benefit from CA. © 2013 Heart Rhythm Society.


Di Marco, L. Y., Raine, D., Bourke, J. P., & Langley, P. (2013). Characteristics of atrial fibrillation cycle length predict restoration of sinus rhythm by catheter ablation. Heart rhythm : the official journal of the Heart Rhythm Society, 10(9), 1303-1310.

Journal Article Type Article
Online Publication Date Jun 13, 2013
Publication Date Sep 1, 2013
Deposit Date Nov 13, 2014
Journal Heart Rhythm
Print ISSN 1547-5271
Electronic ISSN 1556-3871
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 10
Issue 9
Pages 1303-1310
Public URL
Publisher URL