title: Complex fractionated electrogram distribution and temporal stability in patients undergoing atrial fibrillation ablation.
abstract: 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.
authors: Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
authors: Jean-François
authors: JF
authors: Roux
authors: Sattar
authors: S
authors: Gojraty
authors: Rupa
authors: R
authors: Bala
authors: Christopher F
authors: CF
authors: Liu
authors: Mathew D
authors: MD
authors: Hutchinson
authors: Sanjay
authors: S
authors: Dixit
authors: David J
authors: DJ
authors: Callans
authors: Francis
authors: F
authors: Marchlinski
authors: Edward P
authors: EP
authors: Gerstenfeld
mesh_terms: 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