Prevalence and characteristics of continuous electrical activity in patients with paroxysmal and persistent atrial fibrillation.
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.
Tada
Hiroshi
H
Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA.
Yoshida
Kentaro
K
Chugh
Aman
A
Boonyapisit
Warangkna
W
Crawford
Thomas
T
Sarrazin
Jean-Francois
JF
Kuhne
Michael
M
Chalfoun
Nagib
N
Wells
Darryl
D
Dey
Sujoya
S
Veerareddy
Srikar
S
Billakanty
Sree
S
Wong
Wai Shun
WS
Kalra
Dinesh
D
Kfahagi
Ayman
A
Good
Eric
E
Jongnarangsin
Krit
K
Pelosi
Frank
F
Bogun
Frank
F
Morady
Fred
F
Oral
Hakan
H
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*