The temporal variability of dominant frequency and complex fractionated atrial electrograms constrains the validity of sequential mapping in human atrial fibrillation.
BACKGROUND
It has been proposed that sequential mapping of dominant frequency (DF) and complex fractionated atrial electrograms (CFAE) can identify target sites for ablation of atrial fibrillation (AF). These mapping strategies are valid only if DF and CFAE are temporally stable on the timescale of the mapping procedure. We postulate that DF and CFAE are temporally variable; consequently, sequential mapping can be misleading.


OBJECTIVE
To make prolonged spatially stable multielectrode recordings to assess the temporal stability of DF and CFAE.


METHODS
We recorded electrical activity for 5 minutes with the use of a 64-electrode basket catheter placed in the left atrium of 18 patients presenting for AF ablation. DF and CFAE were determined off-line, and their temporal variability was quantified. Maps created from simultaneous versus sequentially acquired data were compared.


RESULTS
DF was temporally variable: the average temporal coefficient of variation was 22.7% +/- 5.4%. DF sites were transient, meeting criteria for only 22.1 seconds out of 5 minutes. Similarly, CFAEs were transient (average duration of CFAE 8.8 +/- 11.3 seconds). DF and CFAE sequential maps failed to identify 93.0% +/- 12.4% and 35.9% +/- 14.9% of DF and CFAE sites, respectively.


CONCLUSIONS
Because of temporal variability, sequential DF and CFAE maps do not accurately reflect the spatial distribution of excitation frequency during any given sampling interval. The spatial distribution of DF and CFAE sites on maps created with sequential point acquisition depends upon the time at which each site is sampled.
Department of Medicine at the University of Vermont College of Medicine, Burlington, Vermont 05401, USA.
Nicole
N
Habel
Pierre
P
Znojkiewicz
Nathaniel
N
Thompson
Joachim G
JG
Müller
Bryan
B
Mason
James
J
Calame
Susan
S
Calame
Shruti
S
Sharma
Gagan
G
Mirchandani
Deborah
D
Janks
Jason
J
Bates
Arshia
A
Noori
Andreas
A
Karnbach
Daniel L
DL
Lustgarten
Burton E
BE
Sobel
Peter
P
Spector
D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D018780:Body Surface Potential Mapping / Q000295:instrumentation*; D017115:Catheter Ablation; D004562:Electrocardiography / Q000295:instrumentation; D004566:Electrodes; D004594:Electrophysiology; D005260:Female; D006325:Heart Atria / Q000294:innervation / Q000473:pathology; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012815:Signal Processing, Computer-Assisted; D013223:Statistics as Topic; D013997:Time Factors