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Characteristics of Complex Fractionated Electrograms in Nonpulmonary Vein Ectopy Initiating Atrial Fibrillation/Atrial Tachycardia

2009; Wiley; Volume: 20; Issue: 12 Linguagem: Inglês

10.1111/j.1540-8167.2009.01617.x

1540-8167

Li‐Wei Lo, Yenn‐Jiang Lin, HSUAN‐MING TSAO, Shih‐Lin Chang, Yu‐Feng Hu, WEN‐CHIN TSAI, DA‐CHUN TUAN, CHIEN‐JUNG CHANG, Pi-Chang Lee, CHING‐TAI TAI, Weihua Tang, Kazuyoshi Suenari, SHIH‐YU HUANG, Satoshi Higa, Shih-Ann Chen,

Cardiac electrophysiology and arrhythmias

Nonpulmonary vein (PV) ectopy initiating atrial fibrillation (AF)/atrial tachycardia (AT) is not uncommon in patients with AF. The relationship of complex fractionated atrial electrograms (CFAEs) and non-PV ectopy initiating AF/AT has not been assessed. We aimed to characterize the CFAEs in the non-PV ectopy initiating AF/AT.Twenty-three patients (age 53 +/- 11 y/o, 19 males) who underwent a stepwise AF ablation with coexisting PV and non-PV ectopy initiating AF or AT were included. CFAE mapping was applied before and after the PV isolation in both atria by using a real-time NavX electroanatomic mapping system. A CFAE was defined as a fractionation interval (FI) of less than 120 ms over 8-second duration. A continuous CFAE (mostly, an FI < 50 ms) was defined as electrogram fractionation or repetitive rapid activity lasting for more than 8 seconds.All patients (100%) with non-PV ectopy initiating AF or AT demonstrated corresponding continuous CFAEs at the firing foci. There was no significant difference in the FI among the PV ostial or non-PV atrial ectopy or other atrial CFAEs (54.1 +/- 5.6, 58.3 +/- 11.3, 52.8 +/- 5.8 ms, P = 0.12). Ablation targeting those continuous CFAEs terminated the AF and AT and eliminated the non-PV ectopy in all patients (100%). During a follow-up of 7 months, 22% of the patients had an AF recurrence with PV reconnections. There was no recurrence of any ablated non-PV ectopy during the follow-up.The sites of the origin of the non-PV ectopies were at the same location as those of the atrial continuous CFAEs. Those non-PV foci were able to initiate and sustain AF/AT. By limited ablation targeting all atrial continuous CFAEs, the AF could be effectively eliminated.