Effect of flecainide on the extension and localization of complex fractionated electrogram during atrial fibrillation.
OBJECTIVE
Complex fractionated electrogram (CFE) ablation in addition to pulmonary vein isolation is an accepted strategy for the treatment of non-paroxysmal atrial fibrillation (AF). We sought to determine the effect of flecainide on the distribution and extension of CFE areas.


METHODS
Twenty-three non-paroxysmal AF patients were enrolled in this prospective study. A first CFE map was obtained under baseline conditions by sampling 5 s of continuous recording from the distal electrodes of the ablation catheter. Intravenous flecainide (1 mg/kg) was administered over 10 min and followed by 30-min observation time. A second CFE map was obtained with the same modalities. CFE-mean values, CFE areas, and atrial electrogram amplitude were retrieved from the electro-anatomical mapping system (Ensite NavX).


RESULTS
After flecainide administration, CFE-mean values increased (111.5 ± 55.3 vs. 132.3 ± 65.0 ms, p < 0.001) with a decrease of CFE area (32.9%) in all patients. Atrial electrogram amplitude decreased significantly (0.30 ± 0.31 vs. 0.25 ± 0.20 mV, p < 0.001). We observed 80.9% preservation of CFE areas. A CFE mean of 78 ms was the best cutoff for predicting stable CFE areas.


CONCLUSIONS
Flecainide reduces the extension of CFE areas while preserving their spatial localization. A CFE-mean value <80 ms may be crucial to define and locate stable CFE areas.
Department of Heart Disease, Haukeland University Hospital and the Department of Clinical Science, University of Bergen , Bergen , Norway.
Alessandro
A
De Bortoli
Li-Bin
LB
Shi
Yu-Chuan
YC
Wang
Per Ivar
PI
Hoff
Eivind
E
Solheim
Ole-Jørgen
OJ
Ohm
Jian
J
Chen
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography / Q000187:drug effects* / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D005424:Flecainide / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D062211:Spatio-Temporal Analysis; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D005424:Flecainide
ablation; atrial fibrillation; complex fractionated electrograms; flecainide