Complex fractionated electrogram distribution and temporal stability in patients undergoing atrial fibrillation...

Area of Science:

• Electrophysiology
• Cardiology
• Medical Devices

Background:

• Complex fractionated electrograms (CFEs) are implicated in atrial fibrillation (AF) pathophysiology.
• The precise distribution and temporal stability of CFE regions are not well understood.
• Targeting CFEs is a strategy for catheter ablation of AF.

Purpose of the Study:

• To define the distribution and temporal stability of CFE regions in patients with persistent AF.
• To assess the consistency of CFE mapping over short time intervals.
• To evaluate the correlation between sequential CFE maps.

Main Methods:

• Two consecutive left atrial (LA) CFE maps were created prior to AF ablation in 15 patients.
• Electrograms were acquired during AF, with mean cycle length and voltage analyzed.
• CFE-positive sites were defined as mean CL ≤ 120 ms; maps were compared quantitatively and qualitatively.

Main Results:

• No significant difference in the number of CFE-positive regions between sequential maps (12.3 vs 11.3, P=0.06).
• CFEs were most frequently identified at the PV/left atrial junction (73%) and left atrial appendage (77%).
• Sequential maps showed 78% concordance in CFE site identification and a significant correlation (r=0.35, P<0.001).

Conclusions:

• CFE regions are predominantly located near pulmonary veins during persistent AF.
• CFE mapping demonstrates significant temporal stability over approximately 30 minutes.
• These findings support the role of CFEs as stable targets for AF catheter ablation.