Is there a relationship between complex fractionated atrial electrograms recorded during atrial fibrillation and sinus rhythm fractionation?

Sághy, László; Callans, David J.; García, Fermin C.; Lin, David; Marchlinski, Francis E.; Riley, Michael P.; Dixit, Sanjay; Tzou, Wendy S.; Haqqani, Haris M.; Pap, Róbert; Kim, Steven; Gerstenfeld, Edward P.

doi:10.1016/j.hrthm.2011.09.062

Cited by 50 publications

(37 citation statements)

References 25 publications

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“…67 Additionally, the extent of electrogram fractionation in patients with and without AF was similar, and areas of fractionation did not correlate with abnormal voltage or atrial scarring in any patients, suggesting that fractionation was functional in nature. 67 Jadidi et al mapped CFAEs -defined as an electrogram with at least four deflections or continuous activation -in AF, SR and with coronary sinus pacing in 18 patients with AF (nine persistent AF and nine paroxysmal AF).…”

Section: Complex Fractionated Electrograms Are Passive Bystanders In Afmentioning

confidence: 76%

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

Waks

Josephson²

2014

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF), the most common sustained arrhythmia, is a leading cause of stroke, and is associated with significant morbidity and mortality worldwide. Despite its frequency, clinical importance, and advances in technology and our knowledge of the molecular, ionic and physiological fundamentals of cardiac electrophysiology, our limited understanding of the mechanisms that initiate and sustain AF has prevented us from being able to truly cure this arrhythmia with antiarrhythmic drugs and/or ablation. This contrasts with other arrhythmias, such as AV nodal tachycardia or circus movement tachycardia using an accessory pathway, which have well-defined mechanisms and circuits that can be safely targeted with high rates of cure. The observations that AF may have different mechanisms in different patients, and that paroxysmal, persistent and permanent forms of AF may differ in how they are initiated and sustained, only serves to reinforce our lack of understanding of this ubiquitous arrhythmia. Historical Mechanisms of Atrial Fibrillation and the Multiple Wavelet HypothesisInterest and understanding of the mechanism of AF began to take form in the early 1900s. Given the chaotic and irregular nature of AF on the surface electrocardiogram, rapid firing of automatic atrial foci was considered a potential mechanism. However, after the seminal work of Mayer 1 , Mines 2 and Garrey 3 in laying the foundation for describing and understanding reentrant arrhythmias, atrial reentrant circuits emerged as the likely drivers of AF.4-7 Although these theories were conceptually sound, it was impossible to prove a specific mechanism with the technology of the time. Moe et al. demonstrated that it was probabilistically unlikely that a large number of simultaneous wavefronts would all die out simultaneously, and AF would therefore perpetuate. However, if the number of simultaneous wavelets were small and/or below a critical value (between 15 and 30 in Moe's computer model), 9 at some point all reentrant wavefronts would be simultaneously extinguished, and AF would therefore terminate. 8,9 Allessie et al. provided experimental evidence supporting this mechanism in a canine heart model of AF where four to six simultaneous reentrant wavelets were needed to sustain arrhythmia. 10 Further evidence supporting multiple wavelets in AF was demonstrated in a separate model, which evaluated the effect of various antiarrhythmic drugs on canine myocardium. This model demonstrated that termination of AF was associated with a reduction AbstractAtrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice, yet our understanding of the mechanisms that initiate and sustain this arrhythmia remains quite poor. Over the last 50 years, various mechanisms of AF have been proposed, yet none has been consistently observed in both experimental studies and in humans. Recently, there has been increasing interest in understanding how spiral waves or rotors -which are specific, organised forms of functional reentry -su...

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Section: Complex Fractionated Electrograms Are Passive Bystanders In Afmentioning

confidence: 76%

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

Waks

Josephson²

2014

Arrhythmia &Amp; Electrophysiology Review

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“…In a prior study, using a signal amplitude value recorded by 95% of all sampled points as being a cutoff for distinguishing healthy from unhealthy tissue, our group has shown that in truly normal patients (i.e., those without AF), the bipolar voltage cutoff value for healthy LA tissue is >0.50 mV. 11 In the current study using an identical methodology we have identified 0.45 mV as the upper cutoff for identifying relatively healthy LA tissue in patients with AF. Although these values are close, the minor difference may be because of pre-existing fibrosis in the LA posterior wall of patients with AF compared to truly normal patients without AF.…”

Section: Regional Bipolar Voltage Distribution In Left Atriummentioning

confidence: 90%

Contact Electroanatomic Mapping Derived Voltage Criteria for Characterizing Left Atrial Scar in Patients Undergoing Ablation for Atrial Fibrillation

Kapa

Desjardins

Callans

et al. 2014

Cardiovasc electrophysiol

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146

130

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“…8 The bipolar signals recorded during sinus rhythm with the CARTO system before the ablation procedure underwent offline FFT analysis using a custom-developed software implemented in the RMC-5000 (Nihon Kohden, Tokyo, Japan). The CARTO system records a 2.5-second continuous bipolar electrogram at 1000-Hz sampling frequency at each point on the electroanatomic map.…”

Section: Fft Analysismentioning

confidence: 99%

New Substrate-Guided Method of Predicting Slow Conducting Isthmuses of Ventricular Tachycardia

Kuroki

Nogami

Igarashi

et al. 2018

Circ: Arrhythmia and Electrophysiology

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BACKGROUND:Several conducting channels of ventricular tachycardia (VT) can be identified using voltage limit adjustment (VLA) of substrate mapping. However, the sensitivity or specificity to predict a VT isthmus is not high by using VLA alone. This study aimed to evaluate the efficacy of the combined use of VLA and fast-Fourier transform analysis to predict VT isthmuses. METHODS AND RESULTS:VLA and fast-Fourier transform analyses of local ventricular bipolar electrograms during sinus rhythm were performed in 9 postinfarction patients who underwent catheter ablation for a total of 13 monomorphic VTs. Relatively higher voltage areas on an electroanatomical map were defined as high voltage channels (HVCs), and relatively higher fast-Fourier transform areas were defined as highfrequency channels (HFCs). HVCs were classified into full or partial HVCs (the entire or >30% of HVC can be detectable, respectively). Twelve full HVCs were identified in 7 of 9 patients. HFCs were located on 7 of 12 full HVCs. Five VT isthmuses (71%) were included in the 7 full HVC+/ HFC+ sites, whereas no VT isthmus was found in the 5 full HVC+/HFC− sites. HFCs were identical to 9 of 16 partial HVCs. Eight VT isthmuses (89%) were included in the 9 partial HVC+/HFC+ sites, whereas no VT isthmus was found in the 7 partial HVC+/HFC− sites. All HVC+/HFC+ sites predicted VT isthmus with a sensitivity of 100% and a specificity of 80%. CONCLUSIONS:Combined use of VLA and fast-Fourier transform analysis may be a useful method to detect VT isthmuses.

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Is there a relationship between complex fractionated atrial electrograms recorded during atrial fibrillation and sinus rhythm fractionation?

Cited by 50 publications

References 25 publications

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

Contact Electroanatomic Mapping Derived Voltage Criteria for Characterizing Left Atrial Scar in Patients Undergoing Ablation for Atrial Fibrillation

New Substrate-Guided Method of Predicting Slow Conducting Isthmuses of Ventricular Tachycardia

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