Relationship among complex signals, short cycle length activity, and dominant frequency in patients with long-lasting persistent AF: A high-density epicardial mapping study in humans

• Published in: Heart rhythm Vol. 8; no. 11; pp. 1714 - 1719
• Main Authors: Lee, Geoffrey, MBChB, Roberts-Thomson, Kurt, MBBS, PhD, Madry, Andrew, BSc, PhD, Spence, Steven, ACCT, Teh, Andrew, MBBS, Heck, Patrick M., BM, BCh, DM, Kumar, Saurabh, BSc, MBBS, Kistler, Peter M., MBBS, PhD, Morton, Joseph B., MBBS, PhD, Sanders, Prashanthan, MBBS, PhD, Kalman, Jonathan M., MBBS, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2011
• Subjects: Action Potentials - physiology; Adult; Aged; Aged, 80 and over; Atrial fibrillation; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Cardiovascular; Catheter Ablation; Complex fractionated atrial electrogram; Diagnosis, Computer-Assisted; Dominant frequency; Epicardial Mapping - methods; Female; Heart Rate - physiology; Humans; Male; Middle Aged; Reproducibility of Results; DF; Complex fractionated atrial electrogram; AF; Atrial fibrillation; CL; EGM; IQR; interquartile range; electrogram; monophasic action potential; LA; Dominant frequency; CFAE; left atrium; cycle length; MAP
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2011.05.021

Background Complex fractionated atrial electrograms (CFAEs) and regions of high dominant frequency (DF) both may identify sites critical to the maintenance of atrial fibrillation (AF). CFAEs may be defined by either (1) complex multicomponent electrograms (EGMs) and/or continuous electrical activity (multicomponent/continuous EGM) or (2) discrete high-frequency EGMs. Objective The purpose of this study was to test if the 2 definitions of CFAE identify the same arrhythmia substrate and determine the relationship of CFAE to areas of high DF. Methods High-density epicardial mapping of the posterior left atrium was performed in 10 patients with long-lasting persistent AF. Point-by-point analysis was performed to determine the spatial distribution and correlation of CFAE defined as either (1) multicomponent/continuous-EGMs or (2) AF cycle length <120 ms. Additionally, spatial analysis was performed to determine the relationship of high DF sites to CFAE sites defined by each of the 2 definitions. Results The percentage of sites deemed CFAE varied markedly between patients and was different depending on the definition of CFAE adopted. There was a poor correlation between CFAE defined by multicomponent/continuous EGMs and AF cycle length <120 ms ( r = 0.18). High DF sites were arranged in clusters evenly distributed throughout the posterior left atrium, with 4.2 ± 1.0 high DF clusters per patient. Although there was poor point-by-point correlation between multicomponent/continuous EGMs and high DF sites ( r = 0.107), spatial analysis revealed that 96% of multicomponent/continuous EGMs were found adjacent to and partially surrounding (≤5 mm) high DF sites. Conclusion There is poor anatomic overlap between CFAE defined by multicomponent/continuous EGMs and CFAE defined by AF cycle length <120 ms. Multicomponent/continuous EGMs are found adjacent to and surrounding sites of high DF. Further studies are needed to determine the mechanisms responsible for these different signals.