Background: Continuous wavelet transform (CWT) analysis is the novel method to evaluate temporally stable frequency sites in atrial fibrillation (AF). Compared with conventional dominant frequency analysis, CWT analyzes longer sampling time (30 seconds) and can give us information of more stable sites of activation in AF (Figure A). Little is known regarding the site specific electrical stability in left atrium (LA) related to pulmonary vein isolation (PVI).
Objective: To evaluate the electrical stability related to PVI at sites in left atrium (LA) in patients with persistent AF (PeAF) using CWT analysis.
Methods: Pseudo frequency (PF) from CWT analysis was obtained from 9 sites in LA (left atrial appendage, high anterior, anterior, roof, posterior, low posterior, lateral, high septum, low septum) using a 20 closed bipolar electrode catheter during AF both before and after PVI. Mean PF in each LA sites before and after PVI were compared to evaluate the electrical stability related to PVI.
Results: Totally 9810 local closed bipolar EGM were analyzed by CWT from 109 patients (65±10 years, 81 male) with PeAF. There was a significant heterogeneity of changes in PF related to PVI. Roof, posterior, and high septum wall were top 3 sites of high frequency activation before PVI. However, significant decrease of PF was recognized in those areas after PVI. Increase of PF was recognized in left atrial appendage after PVI. No significant change of PF was recognized in other areas (See Figure B).
Conclusion: There was a significant heterogeneity in changes of frequency related to PVI. Roof, posterior, and high septum wall were top 3 sites of high frequency activation before PVI, but highly susceptible to PVI.