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Updated: Jun 17, 2026
Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
The novel electrophysiology of complex fractionated atrial electrograms: insight from noncontact unipolar
Li-Wei Lo1, Satoshi Higa, Yenn-Jiang Lin
1Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Background:
The noncontact mapping (NCM) system possesses the merit of global endocardial recording for unipolar and activation mapping.
Objective:
We aimed to evaluate the unipolar electrogram characteristics and activation pattern over the bipolar complex fractionated atrial electrogram (CFAE) sites during atrial fibrillation (AF).
Methods:
Twenty patients (age 55 +/- 11 years old, 15 males) who underwent NCM and ablation of AF (paroxysmal/persistent = 13/7) were included. Both contact bipolar (32-300 Hz) and NCM virtual unipolar electrograms (0.5-300 Hz) were simultaneously recorded along with the activation pattern (total 223 sites, 11 +/- 4 sites/patient). A CFAE was defined as a mean bipolar cycle length of
Results:
The Group 1A CFAE sites exhibited a shorter unipolar electrogram cycle length (129 +/- 11 vs 164 +/- 20 ms, P < 0.001), and higher percentage of an S-wave predominant pattern (QS or rS wave, 63 +/- 13% vs 35 +/- 13%, P < 0.001) than the Group 2 non-CFAE sites. There was a linear correlation between the bipolar and unipolar cycle lengths (P < 0.001, R = 0.87). Most of the Group 1A CFAEs were located over arrhythmogenic pulmonary vein ostia or nonpulmonary vein ectopy with repetitive activations from those ectopies (62%) or the pivot points of the turning wavefronts (21%), whereas the Group 1B CFAEs exhibited a passive activation (44%) or slow conduction (31%).
Conclusions:
The bipolar repetitive and continuous fractionated CFAEs represented different activation patterns. The former was associated with an S wave predominant unipolar morphology which may represent an important focus for maintaining AF.
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