Impact of pulmonary vein isolation on atrial fibrillation organisation: correlation of intracardiac and surface electrocardiogram measures
Author(s)
Type
Journal Article
Abstract
Introduction
Electrical activity in atrial fibrillation (AF) ranges from organized focal drivers to multiple wavelet re-entry. Understanding the effect of pulmonary vein isolation (PVI) on AF organization is clinically important, as it may optimize treatment strategies and outcomes. This study investigates the impact of PVI on AF organization and explores whether ventricular response regularity, measured from surface electrocardiograms (ECGs), reflects AF dynamics and electrophenotype.
Methods
Patients undergoing first-time PVI at Imperial College Healthcare NHS Trust between 2014 and 2022 were assessed pre- and post-PVI. AF organization was quantified using Shannon entropy (ShEn) and Sample entropy (SampEn) from coronary sinus (CS) electrograms. Ventricular response regularity was evaluated using surface ECG RR interval (RRI) variability and SampEn.
Results
PVI reduced ShEn and SampEn across all CS channels (e.g., SampEn CS 3-4: pre-ablation = 0.907 ± 0.512 vs. post-ablation = 0.790 ± 0.446, p < 0.001). Atrial ShEn and SampEn were correlated with ventricular response both pre- and post-ablation (e.g., correlations between atrial SampEn CS 3-4 and the following ventricular metrics: percentage of RRIs > 50 ms difference: r = 0.077, p = 0.008; normalized mean RRI difference: r = 0.144, p < 0.001; and normalized SampEn: r = 0.168, p < 0.001).
Conclusion
The reduction in atrial ShEn and SampEn post-PVI indicates increased AF organization. The significant correlation between atrial entropy and ventricular variability suggests that AF organization affects ventricular response, assessed via surface ECG metrics. These findings highlight the potential of ECG-based measures as proxies for intracardiac AF organization.
Electrical activity in atrial fibrillation (AF) ranges from organized focal drivers to multiple wavelet re-entry. Understanding the effect of pulmonary vein isolation (PVI) on AF organization is clinically important, as it may optimize treatment strategies and outcomes. This study investigates the impact of PVI on AF organization and explores whether ventricular response regularity, measured from surface electrocardiograms (ECGs), reflects AF dynamics and electrophenotype.
Methods
Patients undergoing first-time PVI at Imperial College Healthcare NHS Trust between 2014 and 2022 were assessed pre- and post-PVI. AF organization was quantified using Shannon entropy (ShEn) and Sample entropy (SampEn) from coronary sinus (CS) electrograms. Ventricular response regularity was evaluated using surface ECG RR interval (RRI) variability and SampEn.
Results
PVI reduced ShEn and SampEn across all CS channels (e.g., SampEn CS 3-4: pre-ablation = 0.907 ± 0.512 vs. post-ablation = 0.790 ± 0.446, p < 0.001). Atrial ShEn and SampEn were correlated with ventricular response both pre- and post-ablation (e.g., correlations between atrial SampEn CS 3-4 and the following ventricular metrics: percentage of RRIs > 50 ms difference: r = 0.077, p = 0.008; normalized mean RRI difference: r = 0.144, p < 0.001; and normalized SampEn: r = 0.168, p < 0.001).
Conclusion
The reduction in atrial ShEn and SampEn post-PVI indicates increased AF organization. The significant correlation between atrial entropy and ventricular variability suggests that AF organization affects ventricular response, assessed via surface ECG metrics. These findings highlight the potential of ECG-based measures as proxies for intracardiac AF organization.
Date Issued
2025-08-06
Date Acceptance
2025-07-24
Citation
Journal of Cardiovascular Electrophysiology, 2025, 36 (10), pp.2529-2538
ISSN
1045-3873
Publisher
Wiley
Start Page
2529
End Page
2538
Journal / Book Title
Journal of Cardiovascular Electrophysiology
Volume
36
Issue
10
Copyright Statement
© 2025 The Author(s). Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40768925
Subjects
AF organization
ablation
atrial fibrillation
entropy
pulmonary vein isolation
ventricular irregularity
ventricular variability
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2025-08-06