Abstract 1834: Temporal Stability of Complex Fractionated Atrial Electrograms in Human Left Atrium during Atrial Fibrillation
Introduction: Complex fractionated atrial electrograms (CFAEs) have been reported as ablative targets for the treatment of atrial fibrillation (AF). However, the temporal stability of CFAEs has not been systemically investigated.
Methods: Six patients (1 female, age 56 ± 3 yrs) who underwent catheter ablation of persistent AF were included in the study. To investigate the temporal stability of CFAEs, two consecutive 3D LA electroanatomic maps, separated with a mean interval of 37 min, were reconstructed in each patient during ongoing AF under the guidance of registered CT image. A novel software package (CFAE Software Module, Biosense Webster Inc.) was used to analyze bipolar electrograms recorded from multiple LA endocardial locations for automated CFAE detection. Interval confidence level (ICL), defined as the number of intervals between consecutive CFAE complexes during 2.5 s recordings, was used to characterize CFAEs. Highly repetitive CFAEs sites, which are thought to be potential ablation targets, were defined as the sites with an ICL of >= 5. In each patient, multiple predefined LA locations with highly repetitive CFAEs in the first map were revisited during the reconstruction of the second map. For the analysis, the LA was divided into 6 areas: pulmonary veins, posterior wall, interatrial septum, roof, mitral annulus, and appendage.
Results: Among the 104 ± 16 and 130 ± 30 LA locations sampled in each patient for the first and second electroanatomic maps, respectively, 29 ± 11 (28 ± 11%) and 44 ± 7.8 (34 ± 9%) were categorized as highly repetitive CFAE sites (P = NS). Highly repetitive CFAE sites were distributed at 4.7 ± 1.0 and 5.2 ± 0.8 of the 6 LA areas in the first and second maps, respectively (P = NS). When comparing the paired maps, we found an incidence of 84% for highly repetitive CFAE sites to be located at the same LA area. Of the 81 highly repetitive CFAE sites on the first map which were re-visited on the second map, 58 (72%) remained as highly repetitive CFAE sites, 19 (23%) became less repetitive CFAE sites, and 4 (5%) became non-CFAE sites.
Conclusions: This study demonstrates that more than 70% of the highly repetitive CFAE sites are temporally stable during AF. Our findings may have significant implications for electrogram-guided AF ablation strategies.