Dataset Information

Complexities in the Atrial Fibrillation-Stroke Relationship: Improving Comprehension of Temporal Discordance, Magnitude Synergism, and Subclinical Atrial Fibrillation -- Three Sources of Consternation for Physicians Who Care for Patients with Atrial Fibrillation.

ABSTRACT: That clinically-documented atrial fibrillation (AF) in association with a variety of elevated clinical/laboratory risk markers is associated with an increased risk of stroke is well known -- regardless of whether the AF is paroxysmal, persistent, or permanent. Moreover, data is accumulating to suggest that the absolute rate of stroke should be expectedly higher with a greater burden of AF and greater degree of comorbid contributors. Relatedly, stroke prevention with chronic oral anticoagulation (OAC) is recommended for AF patients with appropriate risk markers by all major medical, cardiologic, and surgical guideline-writing organizations. However, at least two major clinical concerns about the above AF-stroke statements remain. First, if AF is related to stroke, why then is there not a consistent temporal relationship between a stroke and AF? Second, is there importance to and what should we do about device-detected AF (so-called subclinical AF [SCAF]) in the absence of clinically-recognized AF? This paper is designed to enhance the understanding of these issues and reduce the consternation of physicians who care for patients with AF with respect to them.

SUBMITTER: Reiffel JA

PROVIDER: S-EPMC6244310 | biostudies-other | 2018 Aug

REPOSITORIES: biostudies-other

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Complexities in the Atrial Fibrillation-Stroke Relationship: Improving Comprehension of Temporal Discordance, Magnitude Synergism, and Subclinical Atrial Fibrillation -- Three Sources of Consternation for Physicians Who Care for Patients with Atrial Fibrillation.

Reiffel James A JA

Journal of atrial fibrillation 20180831 2

That clinically-documented atrial fibrillation (AF) in association with a variety of elevated clinical/laboratory risk markers is associated with an increased risk of stroke is well known -- regardless of whether the AF is paroxysmal, persistent, or permanent. Moreover, data is accumulating to suggest that the absolute rate of stroke should be expectedly higher with a greater burden of AF and greater degree of comorbid contributors. Relatedly, stroke prevention with chronic oral anticoagulation ...[more]

PMID: 30505387

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Project description:To develop electrocardiogram (ECG) tools to quantify the number of sources for atrial fibrillation (AF), i.e. spatially stable rotors and focal impulses, and whether they lie in right or left atrium. Intracardiac mapping has recently shown that paroxysmal and persistent AF is sustained by rotors or focal sources that are stable in location and thus targets for limited ablation [focal impulse and rotor modulation (FIRM)] to eliminate AF. Importantly, the numbers and locations of concurrent sources determine both the complexity of AF and the approach for ablation.In 36 AF patients (n = 29 persistent, 63 ± 9 years) in the CONventional ablation with or without Focal Impulse and Rotor Modulation (CONFIRM) trial, we developed phase lock (PL) to quantify spatial repeatability of ECG 'F-waves' between leads over time. Phase lock spectrally quantifies the angle ? between F-wave voltages in planes formed by ECG leads I, aVF, and V1 at successive points in time. We compared PL with ECG spectral dominant frequency (DF) and organizational index (OI) to characterize stable rotors and focal sources validated by intracardiac FIRM mapping. Focal impulse and rotor modulation ablation alone at ?3 sources acutely terminated and rendered AF non-inducible or substantially slowed AF in 31 of 36 patients. Receiver operating characteristics of PL for this endpoint had area under the curve (AUC) = 0.72, and the optimum cut-point (PL = 0.09) had 74% sensitivity, 92% positive predictive value (PPV). Receiver operating characteristics areas for OI and DF were 0.50 and 0.58, respectively. Left (n = 28) or right (n = 3) atrial sources were localized by PL with AUC = 0.85, sensitivity 100%, PPV 30%, and negative predictive value 100%. Spectral DF provided AUC = 0.79. Notably, PL did not comigrate with diagnosis of paroxysmal or persistent AF (P = NS), unlike ECG DF.The novel metric of ECG PL identifies patients with fewer (?3) or greater numbers of stable rotors/focal sources for AF, validated by intracardiac FIRM mapping, and localized them to right or left atria. These data open the possibility of using 12-lead ECG analyses to classify AF mechanistically and plan procedures for right- or left-sided FIRM ablation.

Dataset Information

Complexities in the Atrial Fibrillation-Stroke Relationship: Improving Comprehension of Temporal Discordance, Magnitude Synergism, and Subclinical Atrial Fibrillation -- Three Sources of Consternation for Physicians Who Care for Patients with Atrial Fibrillation.

Publications

Complexities in the Atrial Fibrillation-Stroke Relationship: Improving Comprehension of Temporal Discordance, Magnitude Synergism, and Subclinical Atrial Fibrillation -- Three Sources of Consternation for Physicians Who Care for Patients with Atrial Fibrillation.

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