{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:53:18Z","timestamp":1790635998629,"version":"4.1.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,3,30]],"date-time":"2021-03-30T00:00:00Z","timestamp":1617062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001703","name":"\u00c3\u2030cole Polytechnique F\u00c3\u00a9d\u00c3\u00a9rale de Lausanne","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001703","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Consistently successful patient outcomes following catheter ablation (CA) for treatment of persistent atrial fibrillation (pers-AF) remain elusive. We propose an electrocardiogram (ECG) analysis designed to (1) refine selection of patients most likely to benefit from ablation, and (2) examine the temporal evolution of AF organization indices that could act as clinical indicators of ongoing ablation effectiveness and completeness.<\/jats:p><jats:p><jats:bold>Method:<\/jats:bold> Twelve-lead ECG was continuously recorded in 40 patients (61 \u00b1 8 years) during stepwise CA (step-CA) procedures for treatment of pers-AF (sustained duration 19 \u00b1 11 months). Following standard pre-processing, ECG signals were divided into 10-s epochs and labeled according to their temporal placement: pre-PVI (baseline), dur-PVI (during pulmonary vein isolation), and post-PVI (during complex-fractionated atrial electrograms and linear ablation). Instantaneous frequency (IF), adaptive organization index (AOI), sample entropy (SampEn) and f-wave amplitude (FWA) measures were calculated and analyzed during each of the three temporal steps. Temporal evolution of these measures was assessed using a statistical test for mean value transitions, as an indicator of changes in AF organization. Results were then compared between: (i) patients grouped according to step-CA outcome; (ii) patients grouped according to type of arrhythmia recurrence following the procedure, if applicable; (iii) within the same patient group during the three different temporal steps.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Stepwise CA patient outcomes were as follows: (1) left-atrium (LA) terminated, not recurring (LTN, <jats:italic>n<\/jats:italic> = 8), (2) LA terminated, recurring (LTR, <jats:italic>n<\/jats:italic> = 20), and (3) not LA terminated, all recurring at follow-up (NLT, <jats:italic>n<\/jats:italic> = 12). Among the LTR and NLT patients, recurrence occurred as AF in seven patients and atrial tachycardia or atrial flutter (AT\/AFL) in the remaining 25 patients. The ECG measures indicated the lowest level of organization in the NLT group for all ablation steps. The highest organization was observed in the LTN group, while the LTR group displayed an intermediate level of organization. Regarding time evolution of ECG measures in dur-PVI and post-PVI recordings, stepwise ablation led to increases in AF organization in most patients, with no significant differences between the LTN, LTR, and NLT groups. The median decrease in IF and increase in AOI were significantly greater in AT\/AFL recurring patients than in AF recurring patients; however, changes in the SampEn and FWA parameters were not significantly different between types of recurrence.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Noninvasive ECG measures, though unable to predict arrhythmia recurrence following ablation, show the lowest levels of AF organization in patients that do not respond well to step-CA. Increasing AF organization in post-PVI may be associated with organized arrhythmia recurrence after a single ablation procedure.<\/jats:p>","DOI":"10.3389\/fphys.2021.654053","type":"journal-article","created":{"date-parts":[[2021,3,30]],"date-time":"2021-03-30T06:38:01Z","timestamp":1617086281000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["ECG-Based Indices to Characterize Persistent Atrial Fibrillation Before and During Stepwise Catheter Ablation"],"prefix":"10.3389","volume":"12","author":[{"given":"Anna","family":"McCann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Marc","family":"Vesin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne","family":"Pruvot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Roten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Sticherling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Luca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,3,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.cmpb.2010.02.009","article-title":"Optimal parameters study for sample entropy-based atrial fibrillation organization analysis","volume":"99","author":"Alcaraz","year":"2010","journal-title":"Comput. Methods Prog. Biomed"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2147","DOI":"10.1109\/TBME.2010.2052619","article-title":"Noninvasive assessment of the complexity and stationarity of the atrial wavefront patterns during atrial fibrillation","volume":"57","author":"Bonizzi","year":"2010","journal-title":"IEEE Trans. Biomed. Eng"},{"key":"B3","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1016\/j.hrthm.2010.01.017","article-title":"Outcomes of long-standing persistent atrial fibrillation ablation: a systematic review","volume":"7","author":"Brooks","year":"2010","journal-title":"Heart Rhythm"},{"key":"B4","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1016\/j.bspc.2013.02.005","article-title":"Adaptive frequency tracking of the baseline ECG identifies the site of atrial fibrillation termination by catheter ablation","volume":"8","author":"Buttu","year":"2013","journal-title":"Biomed. Signal Process. Control"},{"key":"B5","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1016\/j.jacep.2016.05.017","article-title":"A high baseline electrographic organization level is predictive of successful termination of persistent atrial fibrillation by catheter ablation","volume":"2","author":"Buttu","year":"2016","journal-title":"JACC Clin. Electrophysiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.hrthm.2017.05.012","article-title":"2017 HRS\/EHRA\/ECAS\/APHRS\/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation","volume":"20","author":"Calkins","year":"2018","journal-title":"Europace"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2504","DOI":"10.1016\/j.jacc.2006.02.047","article-title":"Left atrial ablation versus biatrial ablation for persistent and permanent atrial fibrillation: a prospective and randomized study","volume":"47","author":"Cal\u00f3","year":"2006","journal-title":"J. Am. Coll. Cardiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1007\/s10840-006-9045-1","article-title":"The stepwise ablation approach for chronic atrial fibrillation-evidence for a cumulative effect","volume":"16","author":"D O'Neill","year":"2006","journal-title":"J. Interv. Card Electrophysiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.1016\/j.hrthm.2011.05.008","article-title":"Early temporal and spatial regularization of persistent atrial fibrillation predicts termination and arrhythmia-free outcome","volume":"8","author":"Forclaz","year":"2011","journal-title":"Heart Rhythm"},{"key":"B10","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1161\/CIRCEP.112.000167","article-title":"Noninvasive localization of maximal frequency sites of atrial fibrillation by body surface potential mapping","volume":"6","author":"Guillem","year":"2013","journal-title":"Circ. Arrhythm Electrophysiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.1111\/j.1540-8167.2005.00307.x","article-title":"Catheter ablation of long-lasting persistent atrial fibrillation: critical structures for termination","volume":"16","author":"Ha\u00efssaguerre","year":"2005","journal-title":"J. Cardiovasc. Electrophysiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/S0008-6363(97)00289-7","article-title":"Non-invasive assessment of the atrial cycle length during atrial fibrillation in man: introducing, validating and illustrating a new ECG method","volume":"38","author":"Holm","year":"1998","journal-title":"Cardiovasc. Res"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e003354","DOI":"10.1161\/CIRCEP.115.003354","article-title":"Atrial fibrillation complexity parameters derived from surface ECGs predict procedural outcome and long-term follow-up of stepwise catheter ablation for atrial fibrillation","volume":"9","author":"Lankveld","year":"2016","journal-title":"Circ. Arrhythm Electrophysiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1109\/TBME.2006.888835","article-title":"Cancellation of ventricular activity in the ECG: evaluation of novel and existing methods","volume":"54","author":"Lemay","year":"2007","journal-title":"IEEE Trans. Biomed. Eng"},{"key":"B15","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1109\/MSP.2013.2267931","article-title":"Empirical mode decomposition-based time-frequency analysis of multivariate signals: the power of adaptive data analysis","volume":"30","author":"Mandic","year":"2013","journal-title":"IEEE Signal Process. Mag"},{"key":"B16","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1016\/j.jacc.2009.01.081","article-title":"Clinical predictors of termination and clinical outcome of catheter ablation for persistent atrial fibrillation","volume":"54","author":"Matsuo","year":"2009","journal-title":"JACC"},{"key":"B17","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1109\/TBME.2012.2220639","article-title":"Spatial variability of the 12-lead surface ECG as a tool for noninvasive prediction of catheter ablation outcome in persistent atrial fibrillation","volume":"60","author":"Meo","year":"2012","journal-title":"IEEE Trans. Biomed. Eng"},{"key":"B18","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1007\/s00380-020-01563-7","article-title":"The impact of the dominant frequency of body surface electrocardiography in patients with persistent atrial fibrillation","volume":"35","author":"Murase","year":"2020","journal-title":"Heart Vessels"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2044","DOI":"10.1016\/j.jacc.2003.12.054","article-title":"A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate","volume":"43","author":"Nademanee","year":"2004","journal-title":"J. Am. Coll. Cardiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1007\/s10840-011-9637-2","article-title":"Characteristics and distribution of complex fractionated atrial electrograms and the dominant frequency during atrial fibrillation: relationship to the response and outcome of circumferential pulmonary vein isolation","volume":"34","author":"Okumura","year":"2012","journal-title":"J. Interv. Card. Electrophysiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1111\/j.1540-8167.2009.01523.x","article-title":"Manifestation of left atrial events and interatrial frequency gradients in the surface electrocardiogram during atrial fibrillation: contributions from posterior leads","volume":"20","author":"Petrutiu","year":"2009","journal-title":"J. Cardiovasc. Electrophysiol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1016\/j.sigpro.2008.11.002","article-title":"Multi-signal extension of adaptive frequency tracking algorithms","volume":"89","author":"Prudat","year":"2009","journal-title":"Signal Process"},{"key":"B23","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/0005-1098(78)90005-5","article-title":"Modeling by shortest data description","volume":"14","author":"Rissanen","year":"1978","journal-title":"Automatica"},{"key":"B24","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1161\/CIRCEP.114.001943","article-title":"Five-year outcome of catheter ablation of persistent atrial fibrillation using termination of atrial fibrillation as a procedural endpoint","volume":"8","author":"Scherr","year":"2015","journal-title":"Circulation"},{"key":"B25","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1152\/physrev.00031.2009","article-title":"Pathophysiological mechanisms of atrial fibrillation: a translational appraisal","volume":"91","author":"Schotten","year":"2011","journal-title":"Physiol. Rev"},{"key":"B26","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1109\/10.900245","article-title":"Characterization of atrial fibrillation using the surface ECG: time-dependent spectral properties","volume":"48","author":"Stridh","year":"2001","journal-title":"IEEE Trans. Biomed. Eng"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1111\/jce.13699","article-title":"Surface ECG and intracardiac spectral measures predict atrial fibrillation recurrence after catheter ablation","volume":"29","author":"Szil\u00e1gyi","year":"2018","journal-title":"J. Cardiovasc. Electrophysiol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.jneumeth.2009.10.018","article-title":"Adaptive tracking of EEG oscillations","volume":"186","author":"Van Zaen","year":"2010","journal-title":"J. Neurosci. Methods"},{"key":"B29","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1080\/07853890310004110","article-title":"Heart rate variability and recurrence of atrial fibrillation after electrical cardioversion","volume":"35","author":"Vikman","year":"2003","journal-title":"Ann. Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e0188326","DOI":"10.1371\/journal.pone.0188326","article-title":"Which patients recur as atrial tachycardia rather than atrial fibrillation after catheter ablation of atrial fibrillation?","volume":"12","author":"Yang","year":"2017","journal-title":"PLoS ONE"}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2021.654053\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,30]],"date-time":"2021-03-30T06:38:04Z","timestamp":1617086284000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2021.654053\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,30]]},"references-count":30,"alternative-id":["10.3389\/fphys.2021.654053"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2021.654053","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,30]]},"article-number":"654053"}}