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Indices of bipolar complex fractionated atrial electrograms correlate poorly with each other and atrial fibrillation

Dennis H Lau1, Bart Maesen2, Stef Zeemering3

  • 1Department of Physiology, Maastricht University, Maastricht,The Netherlands; Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Heart Rhythm
|March 17, 2015
PubMed

Insights

Bipolar complex fractionated atrial electrograms (CFAE) poorly reflect atrial fibrillation substrate complexity. Unipolar electrogram fractionation, however, correlates well with AF complexity and conduction block, suggesting it may be a more relevant marker for catheter ablation strategies.

Area of Science:

  • Electrophysiology
  • Cardiac Arrhythmias
  • Medical Device Technology

Background:

  • The pathophysiological significance of complex fractionated atrial electrograms (CFAE) in atrial fibrillation (AF) is not well understood.
  • Current understanding of CFAE in AF pathophysiology is limited, impacting treatment strategies.

Purpose of the Study:

  • To investigate the correlation between bipolar CFAE and unipolar electrogram fractionation.
  • To assess the relationship between CFAE and the underlying electrophysiological substrate of AF.
  • To evaluate the impact of electrode characteristics on CFAE detection.

Main Methods:

  • High-density unipolar electrograms from the left atrium of 20 AF patients were recorded.
  • Five semiautomated bipolar CFAE algorithms were evaluated against AF substrate complexity measures.
  • The influence of interelectrode spacing and orientation on bipolar CFAE was examined.

Main Results:

  • All tested bipolar CFAE algorithms showed poor correlation with AF substrate complexity and unipolar electrogram fractionation.
  • Increased interelectrode spacing generally increased bipolar CFAE detection, with one exception.
  • Unipolar fractionation index correlated well with AF substrate complexity, indicating its potential as a marker for conduction block.

Conclusions:

  • Bipolar CFAE analysis appears to lack significant pathophysiological relevance in AF.
  • The limited success of CFAE-targeted catheter ablation may stem from the poor correlation of bipolar CFAE with AF substrate.
  • Unipolar electrogram fractionation shows promise as a more accurate marker for AF substrate and conduction block.
Abstract

Keywords:
Atrial fibrillationCatheter ablationElectrogram fractionationMapping

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