Key result
AF is linked to ~62% lower bipolar voltage versus SR, indicating CFAEs do not reflect damage.
Why the study?
Do complex fractionated atrial electrograms and high dominant frequency sites reflect low voltage substrates during sinus rhythm in patients with atrial fibrillation?
Observational (n=16)
No
Do complex fractionated atrial electrograms and high dominant frequency sites reflect low voltage substrates during sinus rhythm in patients with atrial fibrillation?
Absolute Event Rate: 1% vs 2.6%
p-value: p=<0.01
CFAEs and high DF areas during AF do not reflect damaged atrial myocardium as shown by sinus rhythm voltage, but they demonstrate different electrophysiologic properties during AF.
Caution against AF voltage mapping for substrate assessment; leaves open whether CFAE/DF sites should guide ablation.
Background Ablation targeting complex fractionated atrial electrograms (CFAEs) or high dominant frequency (DF) sites is generally effective for persistent atrial fibrillation (AF). CFAEs and/or high DF sites may exist in low‐voltage regions, which theoretically represent abnormal substrates. However, whether CFAEs or high DF sites reflect low voltage substrates during sinus rhythm (SR) is unknown. Methods Sixteen patients with AF (8 with paroxysmal AF; 8, persistent AF) underwent high‐density mapping of the left atrium (LA) with a 3‐dimensional electroanatomic mapping system before ablation. The LA was divided into 7 segments and the mean bipolar voltage recorded during AF and SR, CFAEs (cycle lengths of 50–120 ms), and DF sites were assessed in each segment with either a duo‐decapolar ring catheter (n=10) or a 64‐pole basket catheter (n=6). Low‐voltage areas were defined as those of <0.5 mV during AF and <1.0 mV during SR. Results Regional mean voltage recorded from the basket catheter showed good correlation between AF and SR (r=0.60, p <0.01); however, the % low‐voltage area in the LA recorded from the ring catheter showed weak correlation (r=0.34, p =0.05). Mean voltage was lower during AF than during SR (1.0 mV [IQR, 0.5–1.4] vs. 2.6 mV [IQR, 1.8–3.6], p <0.01). The regional and overall % low‐voltage area of the LA was greater during AF than during SR (20% vs. 11%, p =0.05). CFAEs and high DF sites (>8 Hz) did not correlate with % low‐voltage sites during SR; however, CFAEs sites were located in high‐voltage regions during AF and high DF sites were located in low voltage regions during AF. Conclusions CFAEs and high DF areas during AF do not reflect damaged atrial myocardium as shown by the SR voltage. However, CFAEs and high DF sites may demonstrate different electrophysiologic properties because of different voltage amplitude during AF.
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Sasaki et al. (2016) conducted an observational in Atrial fibrillation (n=16). Left atrial mapping during atrial fibrillation vs. Left atrial mapping during sinus rhythm was evaluated on Mean bipolar voltage (p=<0.01). Mean left atrial bipolar voltage was significantly lower during atrial fibrillation compared to sinus rhythm (1.0 mV vs. 2.6 mV, p<0.01), indicating that CFAEs and high DF areas do not reflect damaged atrial myocardium.
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