The Regional Distribution and Correlation between Complex Fractionated Atrial Electrograms and Dominant Frequency during Atrial Fibrillation

Background: Complex fractionated atrial electrograms (CFAEs) and dominant frequency (DF) mapping have been proposed to be promising targets for atrial fibrillation (AF) ablation. However, the relationship between CFAEs and DF is unknown. This study investigated the regional distribution, electrogram morphology, and spectral characteristics of complex fractionated atrial electrograms (CFAEs).Methods: Sixteen patients with paroxysmal AF (age=45±10, male=12) and 18 with persistent AF (age=51±13, male=16) undergoing AF ablation were included in the study. Frequency domain analysis was performed on the intracardiac electrograms (6.82 seconds, I KHz/channel) recorded from each of pulmonary veins (PVs), left atrium (LA), right atrium, and coronary sinus during AF. The largest peak frequency was identified as the DF.Results: Intracardiac atrial bipolar electrograms during AF were classified into 3 types; CFAE-Ⅰ defined as rapid discrete electrograms: CFAE-Ⅱ defined as continuous fractionated electrograms; and other electrograms were defined as non-CFAE. CFAE-Ⅰ were found mostly in PV, while CFAE-Ⅱwere observed more frequently in LA in both persistent and paroxysmal AF. CFAE-Ⅰ were associated with high DF, whereas non-CFAE were associated with the low DF. CFAE-Ⅰ consistently related with high DF in all areas of interest in both AF groups. However, CFAE-Ⅱ was related with high DF only in PV and LA in persistent AF.Conclusion: The disparities found between persistent and paroxysmal AF in morphology, distribution, and DF value may reflect the different roles of CFAEs in AF maintenance observed between both groups.

[1]  Rahul Wadke,et al.  Atrial fibrillation. , 2022, Disease-a-month : DM.

[2]  Shih‐Ann Chen,et al.  Interactions of Aging and Hydrogen Peroxide on Pulmonary Vein Electrical Activity: Implications in the Pathophysiology of Atrial Fibrillation , 2011 .

[3]  P. Chang,et al.  Cardiac Resynchronization Therapy in Patients with and without Atrial Fibrillation , 2011 .

[4]  L. Lo,et al.  The Novel Electrophysiology of Complex Fractionated Atrial Electrograms: Insight from Noncontact Unipolar Electrograms , 2009, Journal of cardiovascular electrophysiology.

[5]  Hsuan-Ming Tsao,et al.  Frequency analysis in different types of paroxysmal atrial fibrillation. , 2006, Journal of the American College of Cardiology.

[6]  Robert Ploutz-Snyder,et al.  Mechanisms of Wave Fractionation at Boundaries of High-Frequency Excitation in the Posterior Left Atrium of the Isolated Sheep Heart During Atrial Fibrillation , 2006, Circulation.

[7]  B. Stambler,et al.  Mapping of Atrial Activation During Sustained Atrial Fibrillation in Dogs with Rapid Ventricular Pacing Induced Heart Failure: Evidence for a Role of Driver Regions , 2005, Journal of cardiovascular electrophysiology.

[8]  C. Tai,et al.  Electrophysiological Characteristics and Catheter Ablation in Patients With Paroxysmal Right Atrial Fibrillation , 2005, Circulation.

[9]  OmerBerenfeld,et al.  Spectral Analysis Identifies Sites of High-Frequency Activity Maintaining Atrial Fibrillation in Humans , 2005 .

[10]  C. Tai,et al.  Characterization of Right Atrial Substrate in Patients with Supraventricular Tachyarrhythmias , 2005, Cardiovascular Electrophysiology.

[11]  K. Nademanee,et al.  A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. , 2004, Journal of the American College of Cardiology.

[12]  Mattias Duytschaever,et al.  Fractionation of Electrograms and Linking of Activation During Pharmacologic Cardioversion of Persistent Atrial Fibrillation in the Goat , 2004, Journal of cardiovascular electrophysiology.

[13]  Ulrich Schotten,et al.  The role of atrial dilatation in the domestication of atrial fibrillation. , 2003, Progress in biophysics and molecular biology.

[14]  David E. Haines,et al.  Frequency domain algorithm for quantifying atrial fibrillation organization to increase defibrillation efficacy , 2001, IEEE Transactions on Biomedical Engineering.

[15]  D. Haines,et al.  Assessment of Global Atrial Fibrillation Organization to Optimize Timing of Atrial Defibrillation , 2001, Circulation.

[16]  M. Mansour,et al.  Left-to-Right Gradient of Atrial Frequencies During Acute Atrial Fibrillation in the Isolated Sheep Heart , 2001, Circulation.

[17]  S Nattel,et al.  Promotion of atrial fibrillation by heart failure in dogs: atrial remodeling of a different sort. , 1999, Circulation.

[18]  A. Skanes,et al.  Spatiotemporal periodicity during atrial fibrillation in the isolated sheep heart. , 1998, Circulation.

[19]  A. Bollmann,et al.  Frequency analysis of human atrial fibrillation using the surface electrocardiogram and its response to ibutilide. , 1998, The American journal of cardiology.

[20]  M. Spach,et al.  Relating Extracellular Potentials and Their Derivatives to Anisotropic Propagation at a Microscopic Level in Human Cardiac Muscle: Evidence for Electrical Uncoupling of Side‐to‐Side Fiber Connections with Increasing Age , 1986, Circulation research.

[21]  J A ABILDSKOV,et al.  Atrial fibrillation as a self-sustaining arrhythmia independent of focal discharge. , 1959, American heart journal.

[22]  Prashanthan Sanders,et al.  High-density activation mapping of fractionated electrograms in the atria of patients with paroxysmal atrial fibrillation. , 2006, Heart rhythm.