The optimal automatic algorithm for the mapping of complex fractionated atrial electrograms in patients with atrial fibrillation.
CFAEs and the Voltage. Introduction: Catheter ablation of atrial fibrillation (AF) can be guided by the identification of complex fractionated atrial electrograms (CFAEs). We aimed to study the prediction of the CFAEs defined by an automatic algorithm in different atrial substrates (high voltage areas vs low voltage areas). Methods and Results: This study included 13 patients (age = 56 +/- 12 years, paroxysmal AF = 8 and persistent AF = 5), who underwent mapping and catheter ablation of AF with a NavX system. High-density voltage mapping of the left atrium (LA) was performed during sinus rhythm (SR) (248 +/- 75 sites per patient) followed by that during AF (88 +/- 24 sites per patient). The CFAE maps were based on the automatic-detection algorithm. "Operator-determined CFAEs" were defined according to Nademannee's criteria. A low-voltage zone (LVZ) was defined as a bipolar voltage of less than 0.5 mV during SR. Among a total of 1150 mapping sites, 459 (40%) were categorized as "operator-determined CFAE sites," whereas 691 (60%) were categorized as "operator-determined non-CFAE sites." The sensitivity and negative predictive value increased as the fractionated interval (FI) value of the automatic algorithm increased, but the specificity and positive predictive value decreased. The automatic CFAE algorithm exhibited the highest combined sensitivity and specificity with an FI of <60 ms for the sites inside the LVZ and FI < 70 ms for the sites outside the LVZ, when compared with a single threshold for both the high- and low-voltage groups combined (i.e., no regard for voltage) (ROC: 0.89 vs 0.86). Conclusions: The clinical relevance of the CFAE map would be improved if the calculated index values were accordingly scaled by the electrogram peak-to-peak amplitude.
Tsai
Wen-Chin
WC
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Lin
Yenn-Jiang
YJ
Tsao
Hsuan-Ming
HM
Chang
Shih-Lin
SL
Lo
Li-Wei
LW
Hu
Yu-Feng
YF
Chang
Chien-Jung
CJ
Tang
Wei-Hua
WH
Tuan
Ta-Chun
TC
Udyavar
Ameya R
AR
Wang
Hi-Hung
HH
Chen
Shih-Ann
SA
D000328:Adult; D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged