Abstract 17011: Correlation of Surface Atrial ECG Dominant Frequency to Intracardiac Atrial Electrogram Dominant Frequency
Ghaith Zaatari, Jorge Bohorquez, Laura McDermott, Raul Mitrani, Catherine Blandon, alex velasquez, Litsa Lambrakos, Jeffrey J Goldberger- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Background: The surface Atrial ECG (A-ECG) is an underused tool in persistent atrial fibrillation (PeAF) that can provide dominant frequency (DF) of atrial activation. The association between A-ECG DF and left (LA) and right atrial (RA) DF has not been established.
Research Question: Does surface A-ECG DF correlate with intracardiac DF?
Aims: To investigate the correlation between A-ECG peak DF and peak DF of intracardiac RA and LA electrograms (EGM) in patients with PeAF.
Methods: Thirty-two patients (age 63±9 years; 71% males) with PeAF underwent 5-minute epochs of surface ECG and comprehensive LA (261.5±185.1 sites/patient) and RA (211.5±174.6 sites/patient) intracardiac mapping with 15 second recordings. The A-ECG was derived by QRST subtraction and independent component analysis filtering, and divided into overlapping10-second windows which were subjected to Fast Fourier Transform (FFT). 4 were excluded for significant artifact. A-ECG DF was calculated for each lead from the power spectrum as the average of all 10-second segments. Peak A-ECG DF was determined by regional lead location and for all 12 leads. The intracardiac EGM DF was calculated from the FFT, and peak RA and LA DF was determined.
Results: A-ECG peak DF was significantly lower than intracardiac peak DF 6.08±0.64 vs 9.72±1.19 Hz, p<0.0001(LA: 9.72±1.20 Hz, p<0.0001; RA: 8.40±0.80 Hz, p<0.0001). Figure shows that A-ECG peak DF correlated with peak RA DF, r=0.77 (p<0.0001), but not with peak LA DF (r=0.31, p=0.10). Regional A-ECG lead group DF correlated with RA DF (Inferior (II, III, aVF): r=0.79, p<0.0001; Lateral (I, aVL, V5-6): r=0.78, p<0.0001; Anterior (V1-3): r=0.75, p<0.0001) but not with peak LA DF.
Conclusion: Surface A-ECG DF correlates with intracardiac RA DF and not LA DF. As in atrial flutter, the RA plays a prominent role in the surface ECG manifestation of the f waves. Further study is needed to determine whether A-ECG DF can be used to identify RA versus LA drivers that may require ablation.