Characteristics of complex fractionated electrograms in nonpulmonary vein ectopy initiating atrial fibrillation/atrial tachycardia.
BACKGROUND
Nonpulmonary vein (PV) ectopy initiating atrial fibrillation (AF)/atrial tachycardia (AT) is not uncommon in patients with AF. The relationship of complex fractionated atrial electrograms (CFAEs) and non-PV ectopy initiating AF/AT has not been assessed. We aimed to characterize the CFAEs in the non-PV ectopy initiating AF/AT.


METHODS
Twenty-three patients (age 53 +/- 11 y/o, 19 males) who underwent a stepwise AF ablation with coexisting PV and non-PV ectopy initiating AF or AT were included. CFAE mapping was applied before and after the PV isolation in both atria by using a real-time NavX electroanatomic mapping system. A CFAE was defined as a fractionation interval (FI) of less than 120 ms over 8-second duration. A continuous CFAE (mostly, an FI < 50 ms) was defined as electrogram fractionation or repetitive rapid activity lasting for more than 8 seconds.


RESULTS
All patients (100%) with non-PV ectopy initiating AF or AT demonstrated corresponding continuous CFAEs at the firing foci. There was no significant difference in the FI among the PV ostial or non-PV atrial ectopy or other atrial CFAEs (54.1 +/- 5.6, 58.3 +/- 11.3, 52.8 +/- 5.8 ms, P = 0.12). Ablation targeting those continuous CFAEs terminated the AF and AT and eliminated the non-PV ectopy in all patients (100%). During a follow-up of 7 months, 22% of the patients had an AF recurrence with PV reconnections. There was no recurrence of any ablated non-PV ectopy during the follow-up.


CONCLUSIONS
The sites of the origin of the non-PV ectopies were at the same location as those of the atrial continuous CFAEs. Those non-PV foci were able to initiate and sustain AF/AT. By limited ablation targeting all atrial continuous CFAEs, the AF could be effectively eliminated.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Li-Wei
LW
Lo
Yenn-Jiang
YJ
Lin
Hsuan-Ming
HM
Tsao
Shih-Lin
SL
Chang
Yu-Feng
YF
Hu
Wen-Chin
WC
Tsai
Da-Chun
DC
Tuan
Chien-Jung
CJ
Chang
Pi-Chang
PC
Lee
Ching-Tai
CT
Tai
Wei-Hua
WH
Tang
Kazuyoshi
K
Suenari
Shih-Yu
SY
Huang
Satoshi
S
Higa
Shih-Ann
SA
Chen
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000209:etiology*; D018780:Body Surface Potential Mapping / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013612:Tachycardia, Ectopic Atrial / Q000175:diagnosis* / Q000209:etiology*