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Anatomical hotspots of fractionated electrograms in the left and right atrium: do they exist?

Roeliene Starreveld1, Lisette J M E van der Does1, Natasja M S de Groot1

  • 1Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, CA, Rotterdam, the Netherlands.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|April 25, 2018
PubMed

Insights

Targeting complex fractionated electrograms (CFEs) is not effective for drug-refractory atrial fibrillation (AF). Fractionation occurs widely in both atria, without specific hotspots, necessitating research to differentiate physiologic from pathologic CFEs for effective ablation.

Area of Science:

  • Electrophysiology
  • Cardiology
  • Medical Research

Background:

  • Atrial fibrillation (AF) remains a significant challenge, particularly drug-refractory cases.
  • Complex fractionated electrograms (CFEs) are implicated in AF pathophysiology, but their targeting has not yet proven beneficial.
  • Understanding the anatomical distribution of CFEs is crucial for identifying potential therapeutic targets.

Purpose of the Study:

  • To investigate the anatomical distribution of fractionated electrograms within the atria.
  • To determine if specific atrial regions serve as hotspots for fractionated electrograms.
  • To inform strategies for ablative therapy in drug-refractory atrial fibrillation.

Main Methods:

  • A structured literature search was conducted using PubMed.
  • Included studies involved human atrial electrophysiological measurements (n=565).
  • Analyzed 36 articles detailing the pre-ablation distribution of fractionated electrograms in the left and/or right atria across multiple regions.

Main Results:

  • Fractionated electrograms were found in high proportions across all regions of both the left and right atria.
  • No specific anatomical hotspots for fractionated electrograms were identified.
  • The distribution of fractionated electrograms did not differ between patients with paroxysmal AF and persistent AF.

Conclusions:

  • The widespread distribution of fractionated electrograms suggests that simply targeting all CFEs is not a viable strategy for AF treatment.
  • Different electrophysiological causes and measurement properties complicate the identification of the true arrhythmogenic substrate.
  • Further research is needed to differentiate 'physiologic CFEs' from 'pathologic CFEs' that may be targets for ablative therapy.
Abstract

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