Characteristics of Complex Fractionated Atrial Electrogram in the Electroanatomically Remodeled Left Atrium of Patients With Atrial Fibrillation

Abstract

Background: Complex fractionated atrial electrogram (CFAE) guided ablation is effective in some patients with persistent atrial fibrillation (PeAF), but the pattern of CFAE may be different in the remodeled left atrium (LA). Methods and Results:In 100 AF patients (83 males, 55.0±10.6 years old) with AF (51 paroxysmal AF (PAF), 49 PeAF) who underwent catheter ablation, CFAE cycle length (CL) and distribution (NavX 3D map) were compared according to the LA volume (3D-CT) and endocardial voltage (during high right atrial pacing 500-ms (VolPACE) and AF (VolAF; NavX). The mean CFAE-CL was longer (P=0.003) and the % area CFAE was smaller (P=0.006) in patients with LA ≥125 ml than those with <125 ml. The mean CFAE-CL was longer in patients with VolPACE <1.7 mV than those with ≥1.7 mV (P=0.002) and in VolAF <0.7 mV than ≥0.7 mV (P<0.001). The % area CFAE was smaller in patients with VolPACE <1.7 mV than those with ≥1.7 mV (P=0.006). The incidence of septal CFAE was consistently high, regardless of the degree of LA remodeling. Conclusions:In the AF patients with an electroanatomically remodeled LA, the % area of CFAE was smaller and mean CFAE-CL was longer than in those with a less remodeled LA. However, the majority of CFAE are consistently positioned on the septum in the remodeled LA. (Circ J 2010; 74: 1557 - 1563

Does Location of Epicardial Adipose Tissue Correspond to Endocardial High Dominant Frequency or Complex Fractionated Atrial Electrogram Sites During Atrial Fibrillation?

“…The settings included a refractory period of 40 ms, a peak-to-peak sensitivity between 0.05 mV and 0.1 mV, and a duration of 10 ms. Continuous CFAEs were defined as having a mean fractionation interval <50 ms and variable CFAEs as having a fractionation interval of 50 to 120 ms. [22][23][24] For fast-Fourier transform analysis, DF The bipolar signals obtained from the 5-second recording were analyzed, and the highest peak frequency of the resulting spectrum was identified as the DF. On the DF map produced by the NavX system, a high DF site was defined as a site with a frequency >8 Hz and colored bright purple.…”

High Plasma Concentrations of Transforming Growth Factor-.BETA. and Tissue Inhibitor of Metalloproteinase-1 - Potential Non-Invasive Predictors for Electroanatomical Remodeling of Atrium in Patients With Non-Valvular Atrial Fibrillation -

“…27 Electroanatomical remodeling of LA changes AF dynamics and the characteristics or distribution of complex fractionated atrial electrogram. 28 In this study, plasma concentration of TGF-β and EF were found to be related to the enlargement of LA volume. However, TGF-β might not be a sensitive predictor for the structural remodeling process in AF, because it was associated with enlargement of venous atrium or LAA those remodel at the later phase of LA remodeling.…”

Current Status and Future of Cardiac Mapping in Atrial Fibrillation

“…CFAE regions are predominantly located at the septum, roof, and LA appendage (LAA) with low voltage surrounded by a high voltage area and low conduction velocity in patients with AF. CFAE cycle length was longer, and % area of CFAE was smaller in patients with an enlarged LA or low-voltage LA [34]. High plasma www.intechopen.com concentrations of TGF-beta and TIMP-1 had lower LA voltage and greater LA volume significantly in non-valvular AF patients [35].…”

“…However, this system has limitations in (i) distance problem, between catheter and tissue, decreased accuracy more than 34mm apart from tissue, (ii) signal-to-noise ratio problem, (iii) chamber size dependent, and (iv) virtual electrogram not real one, (v) inadequate substrate mapping and (vi) the associated moderate costs. Recently, an ultrasound-based 3D imaging modality, CARTO-based 3D ultrasound image system (Biosense Webster Inc., USA) has been developed to minimize merge process error [34]. The axial CT images were transferred to the electro-anatomic mapping system equipped with CARTO Merge image integration software (Biosense Webster).…”