Atrial Periodic Source Spectrum From Preoperative Body Surface Potentials Predicts Long-Term Recurrence of Atrial Fibrillation

Objective:
About half of patients experience recurrence of atrial fibrillation (AF) within three to five years after a single catheter ablation procedure. The suboptimality of the long-term outcomes likely results from the inter-patient variability of AF mechanisms, which can be remedied by improved patient screening. We aim to improve the interpretation of body surface potentials (BSPs), such as 12-lead electrocardiograms and 252-lead BSP maps, to aid preoperative patient screening.
Methods:
We developed the Atrial Periodic Source Spectrum (APSS), a novel patient-specific representation based on atrial periodic content, computed on the f-wave segments of patient BSPs, using a second-order blind source separation and a Gaussian Process for regression. With follow-up data, Cox's proportional hazard model was used to select the most relevant feature from preoperative APSSs responsible for AF recurrence.
Results:
Over 138 persistent AF patients, the presence of highly periodic content with cycle lengths between 220–230 ms or 350–400 ms indicates higher risks of 4-year post-ablation AF recurrence (log-rank test, p-value
$< 0.001$
).
Conclusion and Significance:
Preoperative BSPs demonstrate effective prediction in the long-term outcomes, highlighting their potential for patient screening in AF ablation therapy.