Investigation on recurrent high dominant frequency spatiotemporal patterns during persistent atrial fibrillation

Atrial regions hosting dominant frequency (DF) may represent potential drivers of persistent atrial fibrillation (persAF). Previous work showed that DF can exhibit cyclic behaviour. This study aims to better understand the spatiotemporal behaviours of persAF over longer time periods. 10 patients undergoing persAF ablation targeted at DF were included. Left atrial (LA) non-contact virtual electrograms (VEGMs, Ensite Array, St Jude Medical) were collected for up to 5 min pre-/post- ablation. DF was identified as the peak from 4-10 Hz, in 4 s windows (50 % overlap). High DF (HDF) map was created and automated pattern recognition algorithm was applied to look for recurring HDF spatial patterns within each patient. Recurring HDF patterns were found in all patients. Patients who changed rhythm to atrial flutter after ablation demonstrated single dominant pattern (DP) among the recorded time period, which might consistent with the higher level of regularity during flutter. Ablation regularized AF as demonstrated by increased DP recurrence after ablation. The time interval (median [IQR]) of DP recurrence for the patients still in atrial fibrillation(AF) after ablation (7 patients) decreased from 21.1 s [11.8~49.7 s] to 15.7s [6.5~18.2 s]. The proposed method quantifies the spatiotemporal regularity of HDF DPs over long time periods and may offer a more comprehensive dynamic overview of persAF behaviour and the impact of ablation