Areas with complex fractionated atrial electrograms recorded after pulmonary vein isolation represent normal voltage and conduction velocity in sinus rhythm

Juan F. Viles-Gonzalez, J. Anthony Gomes, Marc A. Miller, Srinivas R. Dukkipati, Jacob S. Koruth, Charles Eggert, James Coffey, Vivek Y. Reddy, Andre D'Avila

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

AimsAlthough 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).Methods and resultsComplex 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).ConclusionAreas 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.

Original languageEnglish (US)
Pages (from-to)339-346
Number of pages8
JournalEuropace
Volume15
Issue number3
DOIs
StatePublished - Mar 1 2013

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • CFAE
  • Complex fractionated electrograms
  • Substrate modification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Viles-Gonzalez, J. F., Gomes, J. A., Miller, M. A., Dukkipati, S. R., Koruth, J. S., Eggert, C., Coffey, J., Reddy, V. Y., & D'Avila, A. (2013). Areas with complex fractionated atrial electrograms recorded after pulmonary vein isolation represent normal voltage and conduction velocity in sinus rhythm. Europace, 15(3), 339-346. https://doi.org/10.1093/europace/eus321