Abstract 14214: Comparison of the Activation Sequence Between the Dominant Frequency Site and Complex Fractionated Atrial Electrograms Region Using Contact and Non-contact Mapping: Analysis of Their Role for the Maintenance of Atrial Fibrillation
Objective: To define the role of the dominant frequency (DF) site for the maintenance of AF, we elucidated the activation sequence in DF site and compared it to that in complex fractionated atrial electrograms (CFAE) region.
Methods: Left atrial contact and non-contact mapping was performed using EnSite 3000 in 27 patients (17 paroxysmal and 10 persistent AF). DF >8 Hz was identified as DF site. The area with electrogram cycle length <120 ms was defined as CFAE region. The frequencies of focal discharge, pivoting activation, wave break, wave fusion were compared among the CFAE site which does not overlap with DF site (CFAE-area), DF and CFAE overlapping site (OVL-area) and the DF site which does not overlap with CFAE site (DF-area) during AF.
Results: The area of CFAE-, OVL- and DF-area were 19.32±6.05, 5.02±4.83 and 1.65±2.39 cm2, respectively. The frequency of focal discharge in CFAE-area was significantly higher than those in OVL- and DF-area (2.00±1.82 vs. 0.39±1.14 times/second, P<0.01 and 2.00±1.82 vs. 0±0 times/second, P<0.01). The frequency of pivoting activation in CFAE-area was significantly higher than those in OVL-area and DF-area (3.48±1.83 vs. 0.94±1.39 times/second, P<0.01 and 3.48±1.83 vs. 0.30±061 times/second, P<0.01). The frequency of wave break in CFAE-area was significantly higher than those in OVL-area and DF-area (2.41±1.62 vs. 0.56±0.86 times/second, P<0.01 and 2.41±1.62 vs. 0.30±0.54 times/second, P<0.01). The frequency of wave fusion in CFAE-area was not different from that in OVL-area (1.48±1.48 vs. 0.56±0.78 times/second, P=NS), but was higher than that in DF-area (1.48±1.48 vs. 0.37±0.56 times/second, P<0.01). Based on these findings, pulmonary vein isolation (PVI), roof line lesion and CFAE ablation were performed in a stepwise fashion during AF using an AF termination as a procedural endpoint. AF was terminated in 23 patients (PVI alone in 14, PVI plus roof line lesion in 2 and PVI plus roof line lesion and CFAE ablation in the remaining 7 patients) without the need for further ablation to the DF site in most cases. Radiofrequency energy lesion was observed only in 3 of 59 DF sites.
Conclusions: DF site was not necessarily participated in the maintenance of AF. Rather, the CFAE area plays a crucial role for the maintenance of AF.
- © 2013 by American Heart Association, Inc.