Complex electrograms within the coronary sinus: time- and frequency-domain characteristics, effects of antral pulmonary vein isolation, and relationship to clinical outcome in patients with paroxysmal and persistent atrial fibrillation.
BACKGROUND
The mechanistic and clinical significance of complex fractionated atrial electrograms (CFAE) in the coronary sinus (CS) has been unclear.


RESULTS
Antral pulmonary vein isolation (APVI) was performed in 77 patients with paroxysmal (32) or persistent AF (45). CS electrograms recorded for 60 seconds before and after APVI were analyzed in the time- and frequency-domains. Dominant frequency (DF), complexity index (CI: change in polarity of depolarization), and fractionation index (FI: change in direction of depolarization slope) were determined. Before APVI, there was no difference in DF, CI, or FI between paroxysmal and persistent AF. APVI resulted in a significant decrease in DF, CI, and FI in all patients. Baseline CI (43 +/- 13/s vs 54 +/- 14/s, P = 0.03) and FI (64 +/- 23/s vs 87 +/- 30/s, P = 0.02) were lower in patients with paroxysmal AF who had AF terminated by ablation than who did not. At 10 +/- 2 months, 69% of patients with paroxysmal AF and 49% of patients with persistent AF were free from AF after single ablation. Baseline CI was higher among patients with paroxysmal AF who had AF after APVI (56 +/- 20/s vs 44 +/- 10/s, P = 0.03). In patients with persistent AF, there was a larger decrease in DF after APVI among patients who remained free from AF (13 +/- 11% vs 7 +/- 9%, P < 0.05).


CONCLUSIONS
Complexity of CS electrograms may reflect drivers of AF that perpetuate paroxysmal AF after APVI. In persistent AF, the extent to which APVI decreases DF in the CS correlates with efficacy, suggesting that DF identifies patients who may require additional ablation beyond APVI.
Yoshida
Kentaro
K
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Ulfarsson
Magnus
M
Tada
Hiroshi
H
Chugh
Aman
A
Good
Eric
E
Kuhne
Michael
M
Crawford
Thomas
T
Sarrazin
Jean F
JF
Chalfoun
Nagib
N
Wells
Darryl
D
Jongnarangsin
Krit
K
Pelosi
Frank
F
Bogun
Frank
F
Morady
Fred
F
Oral
Hakan
H
D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping; D002908:Chronic Disease; D054326:Coronary Sinus; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome