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OBJECTIVE: To investigate the mechanisms of chronic atrial fibrillation (AF) and reduce ablation lines for the surgical treatment of AF, we performed the frequency analysis of fibrillation waves using epicardial mapping system.
METHODS: Electrical potentials of fibrillation in the right and left atria were directly collected with 24 epicardial matted bipolar electrodes and 10-pole loop-shaped catheter before AF surgery in operating theater. Atrial electrograms filtered between 0.5 Hz and 60 Hz were recorded for 20 seconds and four-second segments of each electrograms were subjected to fast Fourier transform analysis to calculate the fibrillation cycle length (FCL). From the data of the FCL, we decided the ablation lines at AF surgery.
RESULTS: Frequency analysis guided AF surgery was performed in 32 patients with chronic AF (mean age, 67 ± 9.8 years). The epicardial matted bipolar electrodes was suitable to perform epicardial mapping at free wall of atria and the loop-shaped catheter was suitable at junction of PV-LA and RA-SVC/IVC with its morphological feature. Intraoperative epicardial mapping and analysis of FCL were performed safely in all patients and took about 15 minutes additionally. The mean FCL in right atria tended to be longer (179±38 ms.) than that in left atria (159±29 ms.) in all cohort. On the other hand, FCL in patients with right atrial overload including atrial septal defects and tricuspid regurgitation was significantly shorter (132±31 ms.) than that without overload (194±27 ms. p<0.05) and had more variables. (Figure)
CONCLUSIONS: Intraoperative frequency analysis using epicardial mapping system in patients with chronic AF appeared feasible and faithful. FCL might indicate the overload of atria and be helpful in predicting the electrical driving chamber of AF. This method could provide an alternative operative strategy for the surgical treatment of AF.