title: Areas with complex fractionated atrial electrograms recorded after pulmonary vein isolation represent normal voltage and conduction velocity in sinus rhythm.
abstract: OBJECTIVE
  Although complex fractionated atrial electrograms (CFAEs) are purported to represent critical sites for atrial fibrillation (AF) perpetuation, the mechanism and the significance of CFAE in the genesis of AF remain poorly understood. This study evaluated the relationship between CFAE and areas of abnormal atrial tissue defined by low-voltage electrograms (LVE) and signal average of the P-wave (SAPW).
  
  
  RESULTS
  Complex fractionated atrial electrogram maps were obtained after pulmonary vein isolation in 15 patients with persistent AF. Patients were then cardioverted and voltage/activation maps were acquired in normal sinus rhythm (NSR). Total left atrium (LA), CFAE and LVE areas were measured as % of total LA area (mean ± SD). Conduction velocities of normal, LVE and CFAE areas were also measured during NSR. Patients underwent signal averaged ECG of the P-wave in NSR within 24 h of the procedure. Complex fractionated atrial electrograms areas accounted for 33 ± 24% of total LA. In NSR, only 12 ± 10% of LA area had LVE. There was no anatomic correlation between CFAE sites and LVE; the area of overlap between CFAE and LVE was only 1.6 ± 1.5%. Conduction velocity was faster in CFAE areas (2.3 ± 1.4 m/s) than in normal voltage areas (1.3 ± 0.3 m/s), and LVE areas (1.1 ± 0.7 m/s, P = 0.06). A positive correlation was only found between LVE areas and SAPW duration (r = 0.7, P = 0.04).
  
  
  CONCLUSIONS
  Areas of CFAEs correspond to areas of normal atrial voltage and normal conduction velocity during NSR. Complex fractionated atrial electrogram probably represents the response of normal healthy atrial tissue to rapid pulmonary vein activation.
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai Heart,  Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York City, NY 10029,  USA.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Viles-Gonzalez
authors.forename: J Anthony
authors.initials: JA
authors.lastname: Gomes
authors.forename: Marc A
authors.initials: MA
authors.lastname: Miller
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Dukkipati
authors.forename: Jacob S
authors.initials: JS
authors.lastname: Koruth
authors.forename: Charles
authors.initials: C
authors.lastname: Eggert
authors.forename: James
authors.initials: J
authors.lastname: Coffey
authors.forename: Vivek Y
authors.initials: VY
authors.lastname: Reddy
authors.forename: Andre
authors.initials: A
authors.lastname: d'Avila
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome