Complex fractionated atrial electrograms at anatomic sites of ganglionated plexi in atrial fibrillation

AIMS: To investigate the relationship of complex fractionated atrial electrograms (CFAEs) with the activity of the ganglionated plexi (GP) in the cardiac autonomic nervous system. METHODS AND RESULTS: Thirty-two patients (aged 55 +/- 10 years, five females) scheduled for circumferential ablation for paroxysmal atrial fibrillation (AF) were studied. Mapping of CFAEs during AF was performed at the left atrium (LA) and pulmonary vein-atrial junctions, particularly at the locations where GP are commonly located. Complex fractionated atrial electrograms were identified at >or=1 GP site in 22 of 32 patients (68.8%) and >or=1 LA wall site in 11 patients (34.4%, P < 0.001). In the 10 patients without CFAEs at the GP site, only one patient displayed CFAEs at the LA site. At the site of the left superior GP, CFAEs were recorded in 17 of 32 patients (53.1%), and in 14 (43.8%), 10 (31.3%), 13 (40.6%), and 19 (59.4%) patients at the sites of left inferior, right anterior, right inferior GP, and crux GP, respectively. Ten of 11 patients with CFAEs recorded in the LA wall also displayed CFAE in at least one GP. This association was statistically significant (P = 0.05). In 7 of these 11 patients, CFAEs were also recorded in the LA wall sites adjacent to a GP that also displayed CFAEs. CONCLUSION: Complex fractionated atrial electrograms at presumed anatomic sites of GP were identified in 68.8% patients with paroxysmal AF. In 11 patients without CFAE at the GP, CFAEs were recorded in the LA wall only in one patient. These findings suggest an association between CFAEs and GP.