Background: Areas of complex fractionated atrial electrograms (CFAEs) have been implicated in the atrial substrate of atrial fibrillation (AF). The mechanisms underlying CFAE in humans are not well investigated. Objectives: The purpose of this study was to investigate the regional activation pattern associated with CFAE using a high-density contact mapping catheter. Methods: Twenty patients with paroxysmal AF were mapped using a high-density multielectrode catheter. CFAE were mapped at 10 different sites (left atrium [LA]: inferior, posterior, roof, septum, anterior, lateral; right atrium [RA]: anterior, lateral, posterior, septum). Local atrial fibrillation cycle length (AFCL) was measured immediately before and after the occurrence of CFAE, and the longest electrogram duration (CFAEmax) was assessed. Results: Longer electrogram durations were recorded in the LA compared with the RA (CFAEmax 118 ± 21 ms vs 104 ± 23 ms, P = .001). AFCL significantly shortened before the occurrence of CFAEmax compared with baseline (LA: 174 ± 32 ms vs 186 ± 32 ms, P = .0001; RA: 177 ± 31 ms vs 188 ± 31 ms, P = .0001) and returned to baseline afterwards. AFCL shortened by ≥10 ms in 91% of mapped sites. Two different local activation patterns were associated with occurrence of CFAEmax: a nearly simultaneous activation in all spines in 84% indicating passive activation, and a nonsimultaneous activation sequence suggesting local complex activation or reentry. Conclusion: Fractionated atrial electrograms during AF demonstrate dynamic changes that are dependent on regional AFCL. Shortening of AFCL precedes the development of CFAE; thus, cycle length is a major determinant of fractionation during AF. High-density mapping in AF may help to differentiate passive activation of CFAE from CFAE associated with an active component of the AF process.
- Atrial fibrillation
- Fractionated electrograms
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)