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Type: Journal article
Title: High-density activation mapping of fractionated electrograms in the atria of patients with paroxysmal atrial fibrillation
Author: Rostock, T.
Rotter, M.
Sanders, P.
Takahashi, Y.
Jais, P.
Hocini, M.
Hsu, L.
Sacher, F.
Clementy, J.
Haissaguerre, M.
Citation: Heart Rhythm, 2006; 3(1):27-34
Publisher: Elsevier Inc.
Issue Date: 2006
ISSN: 1547-5271
Statement of
Thomas Rostock, Martin Rotter, Prashanthan Sanders, Yoshihide Takahashi, Pierre Jaïs, Mélèze Hocini, Li-Fern Hsu, Fréderic Sacher, Jacques Clémenty and Michel Haïssaguerre
Abstract: <h4>Background</h4>Areas of complex fractionated atrial electrograms (CFAEs) have been implicated in the atrial substrate of atrial fibrillation (AF). The mechanisms underlying CFAE in humans are not well investigated.<h4>Objectives</h4>The purpose of this study was to investigate the regional activation pattern associated with CFAE using a high-density contact mapping catheter.<h4>Methods</h4>Twenty patients with paroxysmal AF were mapped using a high-density multielectrode catheter. CFAE were mapped at 10 different sites (left atrium [LA]: inferior, posterior, roof, septum, anterior, lateral; right atrium [RA]: anterior, lateral, posterior, septum). Local atrial fibrillation cycle length (AFCL) was measured immediately before and after the occurrence of CFAE, and the longest electrogram duration (CFAEmax) was assessed.<h4>Results</h4>Longer electrogram durations were recorded in the LA compared with the RA (CFAEmax 118 +/- 21 ms vs 104 +/- 23 ms, P = .001). AFCL significantly shortened before the occurrence of CFAEmax compared with baseline (LA: 174 +/- 32 ms vs 186 +/- 32 ms, P = .0001; RA: 177 +/- 31 ms vs 188 +/- 31 ms, P = .0001) and returned to baseline afterwards. AFCL shortened by >or=10 ms in 91% of mapped sites. Two different local activation patterns were associated with occurrence of CFAEmax: a nearly simultaneous activation in all spines in 84% indicating passive activation, and a nonsimultaneous activation sequence suggesting local complex activation or reentry.<h4>Conclusion</h4>Fractionated atrial electrograms during AF demonstrate dynamic changes that are dependent on regional AFCL. Shortening of AFCL precedes the development of CFAE; thus, cycle length is a major determinant of fractionation during AF. High-density mapping in AF may help to differentiate passive activation of CFAE from CFAE associated with an active component of the AF process.
Keywords: Atrial fibrillation
Fractionated electrograms
Description: © 2006 Heart Rhythm Society. Published by Elsevier Inc.
DOI: 10.1016/j.hrthm.2005.09.019
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