TY - JOUR
T1 - High-density activation mapping of fractionated electrograms in the atria of patients with paroxysmal atrial fibrillation
AU - Rostock, Thomas
AU - Rotter, Martin
AU - Sanders, Prashanthan
AU - Takahashi, Yoshihide
AU - Jaïs, Pierre
AU - Hocini, Mélèze
AU - Hsu, Li Fern
AU - Sacher, Fréderic
AU - Clémenty, Jacques
AU - Haïssaguerre, Michel
N1 - Funding Information:
Dr. Rostock is supported by the German Cardiac Society. Dr. Rotter is supported by the Swiss National Foundation for Scientific Research, Bern, Switzerland. Dr. Sanders is supported by the Neil Hamilton Fairley Fellowship from the National Health and Medical Research Council of Australia and the Ralph Reader Fellowship from the National Heart Foundation of Australia. High-density catheters were developed and provided free of charge for the study by Biosense-Webster. Drs. Sanders, Jaïs, and Haïssaguerre have served on the advisory board of, and received lecture fees from, Biosense-Webster.
PY - 2006/1
Y1 - 2006/1
N2 - Background: 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. Objectives: The purpose of this study was to investigate the regional activation pattern associated with CFAE using a high-density contact mapping catheter. Methods: 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. Results: 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 ≥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. Conclusion: 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.
AB - Background: 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. Objectives: The purpose of this study was to investigate the regional activation pattern associated with CFAE using a high-density contact mapping catheter. Methods: 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. Results: 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 ≥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. Conclusion: 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.
KW - Atrial fibrillation
KW - Fractionated electrograms
KW - Mapping
UR - https://www.scopus.com/pages/publications/30444460240
U2 - 10.1016/j.hrthm.2005.09.019
DO - 10.1016/j.hrthm.2005.09.019
M3 - Article
C2 - 16399048
AN - SCOPUS:30444460240
SN - 1547-5271
VL - 3
SP - 27
EP - 34
JO - Heart Rhythm
JF - Heart Rhythm
IS - 1
ER -