Complex fractionated electrogram distribution and temporal stability in patients undergoing atrial fibrillation ablation.
BACKGROUND
Targeting of complex fractionated electrograms (CFEs) has been described as an approach for catheter ablation of atrial fibrillation (AF); however, the distribution and temporal stability of CFE regions remain poorly defined.


METHODS
In patients with persistent AF referred for ablation, we performed two consecutive left atrial (LA) CFE maps prior to AF ablation. Bipolar electrograms were acquired during AF, and the mean AF cycle length and electrogram voltage were automatically determined at each point. Sites with mean CL <or=120 ms were considered CFE positive. The two maps were then compared qualitatively and quantitatively.


RESULTS
A total of 15 patients (93% male, age 56.1 +/- 9.0 years) undergoing AF ablation were studied. The two maps were separated in time by 31 +/- 10 minutes. There was no significant difference in the number of CFE-positive regions (12.3 +/- 5.2 vs 11.3 +/- 4.7; P = 0.06) between the maps. While CFEs were widely distributed within the LA, the PV/left atrial junction (73%) and left atrial appendage (77%) were most often CFE positive. The presence of CFEs at each region was concordant 78% of the time. There was a significant correlation between the two maps (r = 0.35 +/- 0.21, range 0.1-0.84; P < 0.001) with a percent difference of 17.5 +/- 9.4%.


CONCLUSIONS
During persistent AF, most CFE regions are found in the vicinity of the PVs. There is a significant correlation between two CFE maps constructed 31 minutes apart, with 78% concordance of CFE sites.
Roux
Jean-François
JF
Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Gojraty
Sattar
S
Bala
Rupa
R
Liu
Christopher F
CF
Hutchinson
Mathew D
MD
Dixit
Sanjay
S
Callans
David J
DJ
Marchlinski
Francis
F
Gerstenfeld
Edward P
EP
D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome