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Atrial fibrillatory frequency, atrial fibrillatory rate, or atrial cycle length—does it matter?

      In a recent issue of this journal, Fujiki et al
      • Fujiki A
      • Tsuneda T
      • Sugao M
      • Mizumaki K
      • Inoue H
      Usefulness and safety of bepridil in converting persistent atrial fibrillation to sinus rhythm.
      reported on their experience with bepridil, a potassium channel blocker, for conversion of long-lasting atrial fibrillation (AF) in 32 patients. The authors determined atrial cycle length during AF from the surface electrocardiogram at baseline and after drug administration using frequency analysis techniques, and correlated changes in atrial cycle length with conversion success. In short, this method disregards the electrical activity of the ventricles by QRST canceling and uses fast-Fourier transformation to identify the frequency content of the fibrillating atria. The authors find a greater cycle length increase in responders than in nonresponders. Although their results are both interesting and sound from a pathophysiologic point of view, their data analysis contains an important error.
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