Role of high dominant frequency sites in nonparoxysmal atrial fibrillation patients: Insights from high-density frequency and fractionation mapping

Yenn Jiang Lin, Hsuan Ming Tsao, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Chien Jung Chang, Wen Chin Tsai, Kazuyoshi Suenari, Shih Yu Huang, Hsing Ya Chang, Tsu Juey Wu, Shih Ann Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

58 Scopus citations

Abstract

Background: The adjunctive role of dominant frequency (DF) mapping during complex fractionated electrogram (CFE) ablation of atrial fibrillation (AF) has not been clarified. Objective: The purpose of this study was to investigate whether DF distribution or substrate properties are related to fibrillatory activity in the left atrium (LA) and to evaluate the effect of CFE ablation on the different patterns of DF distribution. Methods: The study enrolled 50 nonparoxysmal AF patients who underwent mapping, pulmonary vein isolation, and CFE ablation. High-density DF and CFE mapping were performed from the center of DFmax centrifugally to the rest of the LA. The LA substrate was classified into two types depending on the presence of intra-LA DF gradients as type 1 (>20% of the average DF) or type 2 (<20% of the average DF). Results: In type 1, maximal CFE and DF gradients were observed at the boundary (n = 14) or center (n = 16) of the DFmax region. In type 2 (n = 20), less intra-LA DF gradient was observed (4.27 ± 1.92 Hz vs 1.14 ± 0.52 Hz for types 1 and 2, P <.001) and a large proportion of continuous CFEs extended from the center of DFmax (19% ± 11% and 42% ± 15% of the LA for types 1 and type 2, P = .001). The procedure termination rate and long-term sinus rhythm maintenance rate were lower in patients with a smaller DF gradient (P <.05). Conclusion: The spatial distribution of fractionated activity was associated with particular DF patterns in nonparoxysmal AF patients. Patients with an evident intra-LA DF gradient responded better to pulmonary vein isolation and continuous CFE ablation.

Original languageEnglish
Pages (from-to)1255-1262
Number of pages8
JournalHeart Rhythm
Volume7
Issue number9
DOIs
StatePublished - Sep 2010

Keywords

  • Ablation
  • Atrial fibrillation
  • Electrogram
  • Frequency analysis
  • Left atrium

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