The optimal automatic algorithm for the mapping of complex fractionated atrial electrograms in patients with atrial fibrillation

Wen Chin Tsai, Yenn Jiang Lin, Hsuan Ming Tsao, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Chien Jung Chang, Wei Hua Tang, Ta Chun Tuan, Ameya R. Udyavar, Ji Hung Wang, Shih Ann Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Introduction: Catheter ablation of atrial fibrillation (AF) can be guided by the identification of complex fractionated atrial electrograms (CFAEs). We aimed to study the prediction of the CFAEs defined by an automatic algorithm in different atrial substrates (high voltage areas vs low voltage areas). Methods and Results: This study included 13 patients (age = 56 ± 12 years, paroxysmal AF = 8 and persistent AF = 5), who underwent mapping and catheter ablation of AF with a NavX system. High-density voltage mapping of the left atrium (LA) was performed during sinus rhythm (SR) (248 ± 75 sites per patient) followed by that during AF (88 ± 24 sites per patient). The CFAE maps were based on the automatic-detection algorithm. "Operator-determined CFAEs" were defined according to Nademannee's criteria. A low-voltage zone (LVZ) was defined as a bipolar voltage of less than 0.5 mV during SR. Among a total of 1150 mapping sites, 459 (40%) were categorized as "operator- determined CFAE sites," whereas 691 (60%) were categorized as "operator-determined non-CFAE sites." The sensitivity and negative predictive value increased as the fractionated interval (FI) value of the automatic algorithm increased, but the specificity and positive predictive value decreased. The automatic CFAE algorithm exhibited the highest combined sensitivity and specificity with an FI of <60 ms for the sites inside the LVZ and FI < 70 ms for the sites outside the LVZ, when compared with a single threshold for both the high- and low-voltage groups combined (i.e., no regard for voltage) (ROC: 0.89 vs 0.86). Conclusions: The clinical relevance of the CFAE map would be improved if the calculated index values were accordingly scaled by the electrogram peak-to-peak amplitude.

Original languageEnglish
Pages (from-to)21-26
Number of pages6
JournalJournal of cardiovascular electrophysiology
Issue number1
StatePublished - Jan 2010


  • Atrial fibrillation
  • Catheter ablation
  • Complex fractionated atrial electrograms
  • Electroanatomical mapping
  • Voltage mapping


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