title: Evaluation of the characteristics of rotational activation at high-dominant frequency and complex fractionated atrial electrogram sites during atrial fibrillation.
abstract: BACKGROUND
  High-dominant frequency (DF) and continuous complex fractionated atrial electrogram (CFAE) sites as surrogates for localized sources maintaining atrial fibrillation (AF) are potential AF ablation targets. This study aimed to evaluate the characteristics of a rotational activation at high-DF and continuous CFAE sites in AF patients.
  
  
  METHODS
  Thirty-two consecutive AF patients (5 paroxysmal and 27 non-paroxysmal) underwent ablation using the NavX system. When AF continued after circumferential pulmonary vein isolation (PVI), high-DF sites of ≥8 Hz and continuous CFAE sites (fractionated intervals ≤50 ms) in the left (LA) and right (RA) atria were recorded using a high-density 20-pole circular mapping catheter for 5 s and ablated.
  
  
  RESULTS
  The atrial electrogram characteristics during AF were assessed. A total of 2383 AF beats from 89 high-DF and 19 continuous CFAE sites were investigated. A rotational activation of high-DF and continuous CFAE sites was also observed at 4% and 3% of LA, and 4% and 4% of RA sites, respectively. However, rotational activation was identified in 29 (91%) of 32 patients (mean 3.0±2.6 beats per patient, 80% in the LA). Procedural endpoints were achieved in 26 (81%) of 32 patients: AF termination (n=2) and AF cycle length slowing of >10% (n=26).
  
  
  CONCLUSIONS
  Rotational activation could be identified in high-DF and continuous CFAE sites during AF, but the documentation was limited. Therefore, only limited effects of rotational activation ablation at high-DF and/or continuous CFAE sites following PVI could be concluded.
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kumagai
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Minami
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kutsuzawa
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Oshima
keywords: Ablation; Complex fractionated atrial electrogram; Dominant frequency; Pulmonary vein isolation; Rotor