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Europace Advance Access published online on May 31, 2007
Europace, doi:10.1093/europace/eum096
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Abrupt changes in fibrillatory wave characteristics at the termination of paroxysmal atrial fibrillation in humans

Simona Petrutiu1,3, Alan V. Sahakian1,2,3 and Steven Swiryn1,3,4,*

1 Department of Electrical Engineering and Computer Science, Northwestern University, Evanston, IL, USA; 2 Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA; 3 Evanston Northwestern Healthcare, Evanston, IL, USA; 4 HeartCare Midwest, 5405 N. Knoxville Avenue, Peoria, IL 61614, USA

Aims We investigated the process of spontaneous termination of atrial fibrillation (AF) to determine its time course from the surface ECG.

Methods and results We studied fibrillatory waves in Holter recordings of paroxysmal and sustained AF. Following QRS-T cancellation dominant frequencies (DFs) were computed and the relationship of DF to termination was scrutinized. For 57 episodes of paroxysmal AF (PAF) in 24 patients, DF ranged from 4.4 to 6.5 Hz (5.2 ± 0.4 Hz) compared to 5.8 to 7.4 Hz (6.6 ± 0.6 Hz) for sustained AF recordings. Comparison of the atrial frequency of the ultimate to the penultimate second demonstrated a drop in frequency in 51 of 57 episodes, P < 0.00001. No comparable change was seen at longer time periods. Moments of comparably low frequency without termination were only occasionally seen in patients with PAF but not in patients with sustained AF.

Conclusion Low frequency fibrillation was found to be much more likely to terminate. Frequency changes preceding spontaneous termination were abrupt, in contrast to the gradual frequency drop reported with drug-induced termination. The analysis of fibrillatory wave characteristics and their change over time might be used to target specific moments for pacing therapy in patients with AF.

Key Words: Atrial fibrillation, Cancellation, Spectral analysis, Termination

* Corresponding author. Tel: +1 309 691 4410; fax: +1 309 692 4730. E-mail address: s-swiryn{at}northwestern.edu

Manuscript submitted 19 January 2007. Accepted after revision 17 April 2007.


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