title: Prevalence and characteristics of continuous electrical activity in patients with paroxysmal and persistent atrial fibrillation.
abstract: BACKGROUND
  Complex fractionated atrial electrograms (CFAEs) may play a role in the genesis of atrial fibrillation (AF). One type of CFAE is continuous electrical activity (CEA). The prevalence and characteristics of CEA in patients with paroxysmal and persistent AF are unclear.
  
  
  RESULTS
  In 44 patients (age = 59 +/- 8 years) with paroxysmal (25) or persistent (19) AF, bipolar electrograms were systematically recorded for > or =5 seconds at 24 left atrial (LA) sites, including 8 antral sites, and 2 sites within the coronary sinus (CS). CEA was defined as continuous depolarization for >1 second with no isoelectric interval. CEA was recorded at the LA septum (79%), antrum (66%), posterior (68%) and anterior walls (67%), roof (66%), base of the LA appendage (61%), inferior wall (61%), posterior mitral annulus (48%), CS (41%), and in the LA appendage (14%). Antral CEA was equally prevalent in patients with paroxysmal (63%) and persistent AF (70%, P = 0.12). In patients with paroxysmal AF, the prevalence of CEA was similar among antral and nonantral LA sites, except for the LA appendage. However, in patients with persistent AF, CEA was more prevalent at the nonantral (80%) than antral sites (70%, P = 0.03). CEA at nonantral sites except the CS was more prevalent in persistent than in paroxysmal AF (80% vs 57%, P < 0.001). The mean duration of intermittent episodes of CEA was longer in persistent than in paroxysmal AF (P < 0.001).
  
  
  CONCLUSIONS
  The higher prevalence and duration of CEA at nonantral sites in persistent than in paroxysmal AF is consistent with a greater contribution of LA reentrant mechanisms in persistent AF. However, the high prevalence of CEA at nonantral sites in paroxysmal atrial fibrillation (PAF) suggests that CEA alone is a nonspecific marker of appropriate target sites for ablation of AF. The characteristics of CEA that most accurately identify drivers of AF remain to be determined.
authors: Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA.
authors: Hiroshi
authors: H
authors: Tada
authors: Kentaro
authors: K
authors: Yoshida
authors: Aman
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authors: Chugh
authors: Warangkna
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authors: Boonyapisit
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authors: Crawford
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authors: JF
authors: Sarrazin
authors: Michael
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authors: Wells
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authors: Billakanty
authors: Wai Shun
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authors: Eric
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authors: Good
authors: Krit
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authors: Jongnarangsin
authors: Frank
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authors: Morady
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authors: Oral
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012720:Severity of Illness Index; D013614:Tachycardia, Paroxysmal / Q000453:epidemiology / Q000503:physiopathology*