Document Detail

The novel electrophysiology of complex fractionated atrial electrograms: insight from noncontact unipolar electrograms.
MedLine Citation:
PMID:  20050959     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The noncontact mapping (NCM) system possesses the merit of global endocardial recording for unipolar and activation mapping.
OBJECTIVE: We aimed to evaluate the unipolar electrogram characteristics and activation pattern over the bipolar complex fractionated atrial electrogram (CFAE) sites during atrial fibrillation (AF).
METHODS: Twenty patients (age 55 +/- 11 years old, 15 males) who underwent NCM and ablation of AF (paroxysmal/persistent = 13/7) were included. Both contact bipolar (32-300 Hz) and NCM virtual unipolar electrograms (0.5-300 Hz) were simultaneously recorded along with the activation pattern (total 223 sites, 11 +/- 4 sites/patient). A CFAE was defined as a mean bipolar cycle length of <or= 120 ms with an intervening isoelectric interval of more than 50 ms (Group 1A, n = 63, rapid repetitive CFAEs) or continuous fractionated activity (Group 1B, n = 59, continuous fractionated CFAEs), measured over a 7.2-second duration. Group 2 consisted of those with a bipolar cycle length of more than 120 ms (n = 101).
RESULTS: The Group 1A CFAE sites exhibited a shorter unipolar electrogram cycle length (129 +/- 11 vs 164 +/- 20 ms, P < 0.001), and higher percentage of an S-wave predominant pattern (QS or rS wave, 63 +/- 13% vs 35 +/- 13%, P < 0.001) than the Group 2 non-CFAE sites. There was a linear correlation between the bipolar and unipolar cycle lengths (P < 0.001, R = 0.87). Most of the Group 1A CFAEs were located over arrhythmogenic pulmonary vein ostia or nonpulmonary vein ectopy with repetitive activations from those ectopies (62%) or the pivot points of the turning wavefronts (21%), whereas the Group 1B CFAEs exhibited a passive activation (44%) or slow conduction (31%).
CONCLUSIONS: The bipolar repetitive and continuous fractionated CFAEs represented different activation patterns. The former was associated with an S wave predominant unipolar morphology which may represent an important focus for maintaining AF.
Li-Wei Lo; Satoshi Higa; Yenn-Jiang Lin; Shih-Lin Chang; Ta-Chuan Tuan; Yu-Feng Hu; Wen-Chin Tsai; Hsuan-Ming Tsao; Ching-Tai Tai; Sugako Ishigaki; Asuka Oyakawa; Minetaka Maeda; Kazuyoshi Suenari; Shih-Ann Chen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-12-28
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  21     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-29     Completed Date:  2010-10-19     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  640-8     Citation Subset:  IM    
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MeSH Terms
Atrial Fibrillation / diagnosis*,  surgery*
Catheter Ablation / instrumentation*,  methods*
Data Interpretation, Statistical
Electrocardiography / instrumentation*
Follow-Up Studies
Heart / physiopathology
Heart Atria / physiopathology
Middle Aged
Reproducibility of Results

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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