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Spatial Relationships of Complex Fractionated Atrial Electrograms and Continuous Electrical Activity to Focal Electrical Sources: Implications for Substrate Ablation in Human Atrial Fibrillation.
- Source :
-
JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2017 Nov; Vol. 3 (11), pp. 1220-1228. Date of Electronic Publication: 2017 Aug 02. - Publication Year :
- 2017
-
Abstract
- Objectives: This study sought to evaluate the spatial relationships of focal electrical sources (FSs) to complex fractionated atrial electrograms (CFAE) and continuous electrical activity (CEA).<br />Background: Fractionated atrial electrograms have been associated with atrial fibrillation (AF) drivers in computational studies and represent ablation targets in the management of persistent AF.<br />Methods: We included a subset of 66 patients (age: 63 [56, 67] years, 69% persistent AF) with electroanatomic data from the SELECT AF (Selective complex fractionated atrial electrograms targeting for atrial fibrillation) randomized control trial that compared the efficacy of CFAE with CEA ablation in AF patients undergoing pulmonary vein antral ablation. Focal sources were identified based on bipolar electrogram periodicity and QS unipolar electrogram morphology.<br />Results: A total of 77 FSs (median: 1 [1st quartile, 3rd quartile: 1, 2] per patient) were identified most commonly in the pulmonary vein antrum and left atrial appendage. The proportions of FSs inside CFAE and CEA regions were similar (13% vs. 1.3%, respectively; p = 0.13). Focal sources were more likely to be on the border zone of CFAEs than in CEAs (49% vs. 7.8%, respectively; p = 0.012). Following ablation, 53% of patients had ≥1 unablated extrapulmonary vein FS. The median number of unablated FS was higher in patients with AF recurrence post ablation than in patients without (median: 1 [0, 1] vs. 0 [0, 1], respectively; p = 0.026).<br />Conclusions: One-half of the FSs detected during AF localized to the border of CFAE areas, whereas most of the FSs were found outside CEA areas. CFAE or CEA ablation leaves a number of FS unablated, which is associated with AF recurrence. These findings suggest that many CFAEs may arise from passive wave propagation, remote from FS, which may limit their therapeutic efficacy in AF substrate modification.<br /> (Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Algorithms
Atrial Fibrillation diagnosis
Atrial Fibrillation physiopathology
Body Surface Potential Mapping
Catheter Ablation methods
Cost of Illness
Electricity
Electrophysiologic Techniques, Cardiac instrumentation
Female
Follow-Up Studies
Heart Atria innervation
Heart Atria surgery
Heart Conduction System physiopathology
Humans
Male
Middle Aged
Pulmonary Veins innervation
Pulmonary Veins physiopathology
Pulmonary Veins surgery
Recurrence
Treatment Outcome
Atrial Fibrillation therapy
Catheter Ablation adverse effects
Electrophysiologic Techniques, Cardiac methods
Heart Atria physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 2405-5018
- Volume :
- 3
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- JACC. Clinical electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 29759616
- Full Text :
- https://doi.org/10.1016/j.jacep.2017.05.013