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Comparative distribution of complex fractionated atrial electrograms, high dominant frequency (HDF) sites during
Masayoshi Kofune1, Yasuo Okumura, Ichiro Watanabe
1Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, Japan, 173-8610.
Insights
High dominant frequency sites in sinus rhythm (SR-HDF) do not consistently overlap with complex fractionated atrial electrograms (CFAEs) or high dominant frequency sites during atrial fibrillation (AF-HDF). These findings suggest AF signals primarily reflect functional activity, not structural changes.
Area of Science:
- Electrophysiology
- Cardiac Arrhythmias
- Atrial Fibrillation Pathophysiology
Background:
- Complex fractionated atrial electrograms (CFAEs) and high dominant frequency (HDF) sites during atrial fibrillation (AF) are implicated in AF maintenance.
- Sinus rhythm HDF (SR-HDF) sites are hypothesized to represent abnormal atrial tissue.
- The relationship between SR-HDF and AF-related electrophysiologic signals remains unclear.
Purpose of the Study:
- To investigate the relationship between SR-HDF sites and CFAE and AF-HDF sites during AF.
- To determine if SR-HDF sites correlate with CFAE or AF-HDF during atrial fibrillation.
Main Methods:
- Created NavX-based electrophysiologic maps of CFAE and dominant frequency (DF) in the left atrium/pulmonary veins during AF and SR.
- Analyzed DF maps during SR and AF in 23 patients with paroxysmal AF (PAF) and persistent AF (PerAF).
- Assessed the overlap and agreement between SR-HDF, CFAE, and AF-HDF sites.
Main Results:
- The overlap between SR-HDF and CFAE sites was 51% (poor agreement: kappa=0.07).
- The overlap between SR-HDF and AF-HDF sites was 50% (poor agreement: kappa=0.08).
- Overlap extent did not differ between PAF and PerAF patients; all sites showed normal voltage amplitudes.
Conclusions:
- Most CFAE and AF-HDF sites do not correspond to SR-HDF sites or low-voltage areas during SR in either PAF or PerAF.
- CFAEs and DF signals during AF likely represent functional electrical activity rather than structural atrial remodeling.
Purpose:
Complex fractionated atrial electrograms (CFAEs) and high dominant frequency sites during atrial fibrillation (AF-HDF) are related to the maintenance of atrial fibrillation (AF). HDF sites in sinus rhythm (SR-HDF; as defined by frequencies of >70 Hz) are suggested to be abnormal atrial tissue. Relations between these electrophysiologic signals have not been elucidated.
Methods:
We investigated the relations between SR-HDF and CFAE and AF-HDF sites during AF. NavX-based maps of CFAE and left atrium (LA)/pulmonary vein (PV) dominant frequency (DF) during AF and DF maps during SR were created for 23 patients with AF (paroxysmal AF (PAF), n = 14; persistent AF (PerAF), n = 9).
Results:
The extent of overlap between SR-HDF and CFAE sites was 51 ± 18 % (as calculated by the LA/PV segments containing both an SR-HDF site and a CFAE site/total LA/PV segments containing an CFAE site) and the extent of overlap between SR-HDF and AF-HDF sites was 50 ± 35 % (P = 0.7464). However, statistically poor agreement was noted for both (kappa values, 0.07 ± 0.19 and 0.08 ± 0.24, P = 0.8794). The extent of overlap did not differ between PAF and PerAF patients (SR-HDF and CFAE, 52 % (interquartile range (IQR), 42-59) versus 57 % (IQR, 33-67), P = 0.5842; SR-HDF and AF-HDF, 43 % (IQR, 25-85) versus 55 % (IQR, 13-83), P = 0.9465). The bipolar voltage amplitudes of SR-HDF, CFAE, and AF-HDF sites revealed normal voltage areas (1.6 mV (IQR, 0.8-2.7), 1.9 mV (IQR, 1.1-2.8), and 1.5 mV (IQR, 1.7-2.7), respectively).
Conclusions:
In both PAF and PerAF, most CFAE and AF-HDF sites did not correspond to the SR-HDF sites or low-voltage area during SR. Thus, most CFAE and DF signals during AF represent functional electrical activities rather than structural remodeling of the atria.
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