Session P7A.1

3-D Poincaré Plot Profiles: A Novel Non-Invasive Method to Detect Preferential Ventricular Response during Atrial Fibrillation

AM Climent*, MS Guillem, D Husser, J Millet, A Bollmann

Otto-von-Guericke University
Magdeburg, Germany

Introduction: Atrial fibrillation (AF) is characterized by an unorganized electrical activity of the atria. This is associated with irregular ventricular responses (VR) with typically shorter RR intervals than during normal sinus rhythm .The strategy of rate control during atrial fibrillation (AF) essentially deals with efforts to utilize and adjust the filtering properties of the atrioventricular (AV) node, allowing AF to continue and ensure that ventricular rate is controlled. By constructing histograms of RR intervals during AF, different RR populations can be found. In this work, a new tool based on the 3D Poincaré plots is developed for the characterization of the ventricular response (VR) and the clinical evaluation of rate control therapies.
Methods: In 55 consecutive patients with persistent AF were included in this study. The detection of preferential conductions was evaluated by means of 3D Poincaré plots profile method (3DPPP) and RR interval histogram in 24 hour Holter recordings. In two patients Holter ECGs were recorded before and during rate control treatments with beta blockers or verapamil. Statistical analyses were performed using the paired Student’s t test and Pearson correlation coefficient (p < .05 was considered statistically significant).
Results: By means of RR interval histogram 25 patients (45%) presented two or more RR populations. In 3 of them (5.5 % of the total patients) 3 peaks were automatically detected. Using 3DPPP in 36 patients (65 %) at least two RR populations were automatically detected. In 11 patients (20 % of total patients) three or more peaks were automatically detected. All RR populations found in the RR interval histogram were detected by means of the 3DPPP method. Location of peaks obtained with both methods were highly correlated (R=0.99, p<0.01) with a mean difference between peaks of 20 ± 18 ms. Additionally, 3DPP detected 22 % more RR interval distributions. When two or three peaks were found in the profile, the mean position of peaks 1, 2 and 3 was 459 ± 114 ms, 702 ± 147 ms and 946 ± 251 ms respectively. The three populations were highly correlated (R>0.90, p<0.01). Mean distance between peak 2 and 1 (D21: 246 ± 68 ms) was similar to the one between peak 3 and 2 (D32: 230 ± 78 ms, p=n.s.). In 11 patients in whom three peaks were detected, the difference between D32 and D21 was 15 ± 14 ms (R=0.97, p<0.01).
Discussion and Conclusions: Rate control strategies during AF are an attractive endpoint for the treatment of AF. A new method for evaluating different treatments has been presented. The 3DPPP technique presents an improvement of the 22 % for the detection of preferential conductions. RR interval clusters exhibiting harmonic behaviour have been quantified suggestive of an underlying AV conduction ratio.

(Abstract Control Number: 185)