The regional distribution and correlation between complex fractionated atrial electrograms and dominant frequency during atrial fibrillation

Abstract

Background: Complex fractionated atrial electrograms (CFAEs) and dominant frequency (DF) mapping have been proposed to be promising targets for atrial fibrillation (AF) ablation. However, the relationship between CFAEs and DF is unknown. This study investigated the regional distribution, electrogram morphology, and spectral characteristics of complex fractionated atrial electrograms (CFAEs). Methods: Sixteen patients with paroxysmal AF (age = 45 ± 10, male = 12) and 18 with persistent AF (age = 51 ± 13, male = 16) undergoing AF ablation were included in the study. Frequency domain analysis was performed on the intracardiac electrograms (6.82 seconds, 1 KHz/channel) recorded from each of pulmonary veins (PVs), left atrium (LA), right atrium, and coronary sinus during AF. The largest peak frequency was identified as the DF. Results: Intracardiac atrial bipolar electrograms during AF were classified into 3 types; CFAE-I defined as rapid discrete electrograms; CFAE-II defined as continuous fractionated electrograms; and other electrograms were defined as non-CFAE. CFAE-I were found mostly in PV, while CFAE-II were observed more frequently in LA in both persistent and paroxysmal AF. CFAE-I were associated with high DF, whereas non-CFAE were associated with the low DF. CFAE-I consistently related with high DF in all areas of interest in both AF groups. However, CFAE-II was related with high DF only in PV and LA in persistent AF. Conclusion: The disparities found between persistent and paroxysmal AF in morphology, distribution, and DF value may reflect the different roles of CFAEs in AF maintenance observed between both groups.