Characteristics of complex fractionated electrograms in nonpulmonary vein ectopy initiating atrial fibrillation/atrial tachycardia

Li Wei Lo, Yenn Jiang Lin, Hsuan Ming Tsao, Shih Lin Chang, Yu Feng Hu, Wen Chin Tsai, Da Chun Tuan, Chien Jung Chang, Pi Chang Lee, Ching Tai Tai, Wei Hua Tang, Kazuyoshi Suenari, Shih Yu Huang, Satoshi Higa, Shih Ann Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Complex Fractionated Electrograms from Nonpulmonary Vein Ectopy. Background: Nonpulmonary vein (PV) ectopy initiating atrial fibrillation (AF)/atrial tachycardia (AT) is not uncommon in patients with AF. The relationship of complex fractionated atrial electrograms (CFAEs) and non-PV ectopy initiating AF/AT has not been assessed. We aimed to characterize the CFAEs in the non-PV ectopy initiating AF/AT. Methods: Twenty-three patients (age 53 ± 11 y/o, 19 males) who underwent a stepwise AF ablation with coexisting PV and non-PV ectopy initiating AF or AT were included. CFAE mapping was applied before and after the PV isolation in both atria by using a real-time NavX electroanatomic mapping system. A CFAE was defined as a fractionation interval (FI) of less than 120 ms over 8-second duration. A continuous CFAE (mostly, an FI < 50 ms) was defined as electrogram fractionation or repetitive rapid activity lasting for more than 8 seconds. Results: All patients (100%) with non-PV ectopy initiating AF or AT demonstrated corresponding continuous CFAEs at the firing foci. There was no significant difference in the FI among the PV ostial or non-PV atrial ectopy or other atrial CFAEs (54.1 ± 5.6, 58.3 ± 11.3, 52.8 ± 5.8 ms, P = 0.12). Ablation targeting those continuous CFAEs terminated the AF and AT and eliminated the non-PV ectopy in all patients (100%). During a follow-up of 7 months, 22% of the patients had an AF recurrence with PV reconnections. There was no recurrence of any ablated non-PV ectopy during the follow-up. Conclusion: The sites of the origin of the non-PV ectopies were at the same location as those of the atrial continuous CFAEs. Those non-PV foci were able to initiate and sustain AF/AT. By limited ablation targeting all atrial continuous CFAEs, the AF could be effectively eliminated. (J Cardiovasc Electrophysiol, Vol. 20, pp. 1305-1312, December 2009)

Original languageEnglish
Pages (from-to)1305-1312
Number of pages8
JournalJournal of cardiovascular electrophysiology
Volume20
Issue number12
DOIs
StatePublished - Dec 2009

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Complex fractionated atrial electrograms
  • Pulmonary vein isolation
  • Right atrium

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