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Characteristics and distribution of complex fractionated atrial electrograms in patients with paroxysmal and persistent atrial fibrillation

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Abstract

Introduction

Substrate-based radiofrequency ablation for treatment of atrial fibrillation (AF) is still under development. The purpose of this study was to investigate the different characteristics and distribution of complex fractionated atrial electrograms (CFAE) in both atria in patients with paroxysmal and persistent AF.

Methods and Results

The NavX™ system was used to map the left and right atria and the coronary sinus in 20 AF patients (ten persistent). An automated algorithm calculates the average time interval between consecutive deflections (complex fractionated electrogram (CFE) mean). All recordings were visually inspected off-line and interpreted either as continuous, fragmented, mixed CFAE, or non-CFAE, and their locations were determined. Electrograms with intermittent CFAE characteristics were also regarded as non-CFAEs. There were more CFAEs in persistent AF than in paroxysmal AF (52% vs. 44% of total registrations, p < 0.05), and CFAEs were more widespread in both atria in persistent AF patients. There were also more continuous CFAEs (70% vs. 59% of total CFAEs, p < 0.05), and less mixed and intermittent CFAEs (22% vs. 30% and 16% vs. 21% of total CFAEs, respectively, p < 0.05) in persistent AF. Fragmented CFAEs had more high-voltage signals than other groups. Employing the automated algorithm for CFAE mapping, a CFE mean cut-off value of ≤80 ms provides a sensitivity and specificity of 87.4% and 81.2%, respectively.

Conclusions

CFAEs distribute in preferential areas and arrange in different patterns in both atria. Patients with persistent AF have more continuous CFAEs and higher temporal signal stability than patients with paroxysmal AF.

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References

  1. Haissaguerre, M., Jais, P., Shah, D. C., Garrigue, S., Takahashi, A., Lavergne, T., et al. (2000). Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation, 101, 1409–1417.

    CAS  PubMed  Google Scholar 

  2. Verma, A., Marrouche, N. F., & Natale, A. (2004). Pulmonary vein antrum isolation: Intracardiac echocardiography-guided technique. Journal of Cardiovascular Electrophysiology, 15, 1335–1340.

    Article  PubMed  Google Scholar 

  3. Pappone, C., Oreto, G., Rosanio, S., Vicedomini, G., Tocchi, M., Gugliotta, F., et al. (2000). Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation. Circulation, 102, 2619–2628.

    CAS  PubMed  Google Scholar 

  4. Pachon, M. J., Pachon, M. E., Pachon, M. J., Lobo, T. J., Pachon, M. Z., Vargas, R. N., et al. (2004). A new treatment for atrial fibrillation based on spectral analysis to guide the catheter RF-ablation. Europace, 6, 590–601.

    Article  PubMed  Google Scholar 

  5. Nademanee, K., McKenzie, J., Kosar, E., Schwab, M., Sunsaneewitayakul, B., Vasavakul, T., et al. (2004). A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. Journal of the American College of Cardiology, 43, 2044–2053.

    Article  PubMed  Google Scholar 

  6. Oral, H., Chugh, A., Good, E., Wimmer, A., Dey, S., Gadeela, N., et al. (2007). Radiofrequency catheter ablation of chronic atrial fibrillation guided by complex electrograms. Circulation, 115, 2606–2612.

    Article  PubMed  Google Scholar 

  7. Schmitt, C., Estner, H., Hecher, B., Luik, A., Kolb, C., Karch, M., et al. (2007). Radiofrequency ablation of complex fractionated atrial electrograms (CFAE): Preferential sites of acute termination and regularization in paroxysmal and persistent atrial fibrillation. Journal of Cardiovascular Electrophysiology, 18, 1039–1046.

    Article  PubMed  Google Scholar 

  8. Nademanee, K., Schwab, M., Porath, J., & Abbo, A. (2006). How to perform electrogram-guided atrial fibrillation ablation. Heart Rhythm, 3, 981–984.

    Article  PubMed  Google Scholar 

  9. Elayi, C. S., Verma, A., Di Biase, L., Ching, C. K., Patel, D., Barrett, C., et al. (2008). Ablation for longstanding permanent atrial fibrillation: results from a randomized study comparing three different strategies. Heart Rhythm, 5, 1658–1664.

    Article  PubMed  Google Scholar 

  10. Deisenhofer, I., Estner, H., Reents, T., Fichtner, S., Bauer, A., Wu, J., et al. (2008). Does electrogram guided substrate ablation add to the success of pulmonary vein isolation in patients with paroxysmal atrial fibrillation? A prospective, randomized study. Journal of Cardiovascular Electrophysiology, 20, 514–521.

    Article  PubMed  Google Scholar 

  11. Estner, H. L., Hessling, G., Ndrepepa, G., Wu, J., Reents, T., Fichtner, S., et al. (2008). Electrogram-guided substrate ablation with or without pulmonary vein isolation in patients with persistent atrial fibrillation. Europace, 10, 1281–1287.

    Article  PubMed  Google Scholar 

  12. Oral, H., Chugh, A., Yoshida, K., Sarrazin, J. F., Kuhne, M., Crawford, T., et al. (2009). A randomized assessment of the incremental role of ablation of complex fractionated atrial electrograms after antral pulmonary vein isolation for long-lasting persistent atrial fibrillation. Journal of the American College of Cardiology, 53, 782–789.

    Article  PubMed  Google Scholar 

  13. Roux, J.-F., Gojraty, S., Bala, R., Liu, C. F., Hutchinson, M. D., Dixit, S., et al. (2008). Complex fractionated electrogram distribution and temporal stability in patients undergoing atrial fibrillation ablation. Journal of Cardiovascular Electrophysiology, 19, 815–820.

    Article  PubMed  Google Scholar 

  14. Scherr, D., Dalal, D., Cheema, A., Nazarian, S., Almasry, I., Bilchick, K., et al. (2009). Long- and short-term temporal stability of complex fractionated atrial electrograms in human left atrium during atrial fibrillation. Journal of Cardiovascular Electrophysiology, 20, 13–21.

    Article  PubMed  Google Scholar 

  15. Konings, K. T., Smeets, J. L., Penn, O. C., Wellens, H. J., & Allessie, M. A. (1997). Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans. Circulation, 95, 1231–1241.

    CAS  PubMed  Google Scholar 

  16. Park, J. H., Pak, H.-N., Kim, S. K., Jang, J. K., Choi, J. I., Lim, H. E., et al. (2009). Electrophysiologic characteristics of complex fractionated atrial electrograms in patients with atrial fibrillation. Journal of Cardiovascular Electrophysiology, 20, 266–272.

    Article  PubMed  Google Scholar 

  17. Stiles, M. K., Brooks, A. G., Kuklik, P., John, B., Dimitri, H., Lau, D. H., et al. (2008). High-density mapping of atrial fibrillation in humans: Relationship between high-frequency activation and electrogram fractionation. Journal of Cardiovascular Electrophysiology, 19, 1245–1253.

    Article  PubMed  Google Scholar 

  18. Stiles, M. K., Brooks, A. G., John, B., Shashidinar, Wilson, L., Kuklik, P., et al. (2008). The effect of electrogram duration on quantification of complex fractionated atrial electrograms and dominant frequency. Journal of Cardiovascular Electrophysiology, 19, 252–258.

    Article  PubMed  Google Scholar 

  19. Matsuo, S., Lellouche, N., Wright, M., Bevilacqua, M., Knecht, S., Nault, I., et al. (2009). Clinical predictors of termination and clinical outcome of catheter ablation for persistent atrial fibrillation. Journal of the American College of Cardiology, 54, 788–795.

    Article  PubMed  Google Scholar 

  20. Oral, H., Knight, B. P., Tada, H., Özaydin, M., Chugh, M., Hassan, S., et al. (2002). Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation, 105, 1077–1081.

    Article  PubMed  Google Scholar 

  21. Liu, X., Shi, H.-F., Tan, H.-W., Wang, X.-H., Li, Z., & Gu, J.-N. (2009). Decreased connexin 43 and increased fibrosis in atrial regions susceptible to complex fractionated atrial electrograms. Cardiology, 114, 22–29.

    Article  CAS  PubMed  Google Scholar 

  22. Lin, J., Scherlag, B. J., Zhou, J., Lu, Z., Patterson, E., Jackman, W. M., et al. (2007). Autonomic mechanism to explain complex fractionated atrial electrograms (CFAE). Journal of Cardiovascular Electrophysiology, 18, 1197–1205.

    Article  PubMed  Google Scholar 

  23. Lu, Z., Scherlag, B. J., Lin, J., Niu, G., Ghias, M., Jackman, W. M., et al. (2008). Autonomic mechanism for complex fractionated atrial electrograms: Evidence by fast Fourier transform analysis. Journal of Cardiovascular Electrophysiology, 19, 835–842.

    Article  PubMed  Google Scholar 

  24. Katrisis, D., Giazitzoglou, E., Sougiannis, D., Voridis, E., & Po, S. S. (2009). Complex fractionated atrial electrograms at anatomic sites of ganglionated plexi in atrial fibrillation. Europace, 11, 308–315.

    Article  Google Scholar 

  25. Tada, H., Yoshida, K., Chugh, A., Boonyapisit, W., Crawford, T., Sarrazin, J.-F., et al. (2008). Prevalence and characteristics of continuous electrical activity in patients with paroxysmal and persistent atrial fibrillation. Journal of Cardiovascular Electrophysiology, 19, 606–612.

    Article  PubMed  Google Scholar 

  26. Nademanee, K. (2007). Trials and travails of electrogram-guided ablation of chronic atrial fibrillation. Circulation, 115, 2592–2594.

    Article  PubMed  Google Scholar 

  27. Off, M. K., Solheim, E., Schuster, P., Hoff, P. I., Ohm, O.-J., & Chen, J. (2008). Detection of complex fractionated electrograms by an automated algorithm (abstr). Heart Rhythm, 5, S171.

    Article  Google Scholar 

  28. Wu, J., Estner, H., Luik, A., Ücer, E., Reents, T., Pflaumer, A., et al. (2008). Automatic 3D mapping of complex fractionated atrial electrograms (CFAE) in patients with paroxysmal and persistent atrial fibrillation. Journal of Cardiovascular Electrophysiology, 19, 897–903.

    Article  PubMed  Google Scholar 

  29. Chen, J., Off, M. K., Solheim, E., Hoff, P. I., Schuster, P., & Ohm, O.-J. (2009). Spatial relationships between the pulmonary veins and sites of complex fractionated atrial electrograms during atrial fibrillation. Pacing and Clinical Electrophysiology, 32, S190–S193.

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was partly supported by the Norwegian Foundation for Health and Rehabilitation (Solheim). Schuster received an educational grant from Biosense Webster, and Solheim and Chen have served on the St. Jude Medical advisory board. There are no other conflicts of interest to be disclosed.

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Authors and Affiliations

  1. Department of Heart Disease, Haukeland University Hospital, 5021, Bergen, Norway

    Eivind Solheim, Morten Kristian Off, Per Ivar Hoff, Peter Schuster & Jian Chen

  2. Institute of Medicine, University of Bergen, Bergen, Norway

    Eivind Solheim, Peter Schuster, Ole-Jørgen Ohm & Jian Chen

Authors
  1. Eivind Solheim
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  2. Morten Kristian Off
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  3. Per Ivar Hoff
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  4. Peter Schuster
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  6. Jian Chen
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Correspondence to Eivind Solheim.

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Eivind Solheim and Morten Kristian Off contributed equally to this article.

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Solheim, E., Off, M.K., Hoff, P.I. et al. Characteristics and distribution of complex fractionated atrial electrograms in patients with paroxysmal and persistent atrial fibrillation. J Interv Card Electrophysiol 28, 87–93 (2010). https://doi.org/10.1007/s10840-010-9479-3

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  • DOI: https://doi.org/10.1007/s10840-010-9479-3

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