Areas with complex fractionated atrial electrograms recorded after pulmonary vein isolation represent normal voltage and conduction velocity in sinus rhythm
Although complex fractionated atrial electrograms (CFAEs) are purported to represent critical sites for atrial fibrillation (AF) perpetuation, the mechanism and the significance of CFAE in the genesis of AF remain poorly understood. This study evaluated the relationship between CFAE and areas of abn...
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| Veröffentlicht in: | Europace (London, England) England), 2013-03, Vol.15 (3), p.339-346 |
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| creator | Viles-Gonzalez, Juan F Gomes, J Anthony Miller, Marc A Dukkipati, Srinivas R Koruth, Jacob S Eggert, Charles Coffey, James Reddy, Vivek Y d'Avila, Andre |
| description | Although complex fractionated atrial electrograms (CFAEs) are purported to represent critical sites for atrial fibrillation (AF) perpetuation, the mechanism and the significance of CFAE in the genesis of AF remain poorly understood. This study evaluated the relationship between CFAE and areas of abnormal atrial tissue defined by low-voltage electrograms (LVE) and signal average of the P-wave (SAPW).
Complex fractionated atrial electrogram maps were obtained after pulmonary vein isolation in 15 patients with persistent AF. Patients were then cardioverted and voltage/activation maps were acquired in normal sinus rhythm (NSR). Total left atrium (LA), CFAE and LVE areas were measured as % of total LA area (mean ± SD). Conduction velocities of normal, LVE and CFAE areas were also measured during NSR. Patients underwent signal averaged ECG of the P-wave in NSR within 24 h of the procedure. Complex fractionated atrial electrograms areas accounted for 33 ± 24% of total LA. In NSR, only 12 ± 10% of LA area had LVE. There was no anatomic correlation between CFAE sites and LVE; the area of overlap between CFAE and LVE was only 1.6 ± 1.5%. Conduction velocity was faster in CFAE areas (2.3 ± 1.4 m/s) than in normal voltage areas (1.3 ± 0.3 m/s), and LVE areas (1.1 ± 0.7 m/s, P = 0.06). A positive correlation was only found between LVE areas and SAPW duration (r = 0.7, P = 0.04).
Areas of CFAEs correspond to areas of normal atrial voltage and normal conduction velocity during NSR. Complex fractionated atrial electrogram probably represents the response of normal healthy atrial tissue to rapid pulmonary vein activation. |
| doi_str_mv | 10.1093/europace/eus321 |
| format | Article |
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Complex fractionated atrial electrogram maps were obtained after pulmonary vein isolation in 15 patients with persistent AF. Patients were then cardioverted and voltage/activation maps were acquired in normal sinus rhythm (NSR). Total left atrium (LA), CFAE and LVE areas were measured as % of total LA area (mean ± SD). Conduction velocities of normal, LVE and CFAE areas were also measured during NSR. Patients underwent signal averaged ECG of the P-wave in NSR within 24 h of the procedure. Complex fractionated atrial electrograms areas accounted for 33 ± 24% of total LA. In NSR, only 12 ± 10% of LA area had LVE. There was no anatomic correlation between CFAE sites and LVE; the area of overlap between CFAE and LVE was only 1.6 ± 1.5%. Conduction velocity was faster in CFAE areas (2.3 ± 1.4 m/s) than in normal voltage areas (1.3 ± 0.3 m/s), and LVE areas (1.1 ± 0.7 m/s, P = 0.06). A positive correlation was only found between LVE areas and SAPW duration (r = 0.7, P = 0.04).
Areas of CFAEs correspond to areas of normal atrial voltage and normal conduction velocity during NSR. Complex fractionated atrial electrogram probably represents the response of normal healthy atrial tissue to rapid pulmonary vein activation.</description><identifier>ISSN: 1099-5129</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/eus321</identifier><identifier>PMID: 23148118</identifier><language>eng</language><publisher>England</publisher><subject>Action Potentials ; Aged ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Catheter Ablation ; Chi-Square Distribution ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Female ; Heart Atria - physiopathology ; Heart Conduction System - physiopathology ; Heart Conduction System - surgery ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Pulmonary Veins - physiopathology ; Pulmonary Veins - surgery ; Time Factors ; Treatment Outcome</subject><ispartof>Europace (London, England), 2013-03, Vol.15 (3), p.339-346</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c338t-a000bdb3a5d7fc8460b5c996c172770b5238fdc8234f2fdf7351b46bd5d5b66c3</citedby><cites>FETCH-LOGICAL-c338t-a000bdb3a5d7fc8460b5c996c172770b5238fdc8234f2fdf7351b46bd5d5b66c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23148118$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Viles-Gonzalez, Juan F</creatorcontrib><creatorcontrib>Gomes, J Anthony</creatorcontrib><creatorcontrib>Miller, Marc A</creatorcontrib><creatorcontrib>Dukkipati, Srinivas R</creatorcontrib><creatorcontrib>Koruth, Jacob S</creatorcontrib><creatorcontrib>Eggert, Charles</creatorcontrib><creatorcontrib>Coffey, James</creatorcontrib><creatorcontrib>Reddy, Vivek Y</creatorcontrib><creatorcontrib>d'Avila, Andre</creatorcontrib><title>Areas with complex fractionated atrial electrograms recorded after pulmonary vein isolation represent normal voltage and conduction velocity in sinus rhythm</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>Although complex fractionated atrial electrograms (CFAEs) are purported to represent critical sites for atrial fibrillation (AF) perpetuation, the mechanism and the significance of CFAE in the genesis of AF remain poorly understood. This study evaluated the relationship between CFAE and areas of abnormal atrial tissue defined by low-voltage electrograms (LVE) and signal average of the P-wave (SAPW).
Complex fractionated atrial electrogram maps were obtained after pulmonary vein isolation in 15 patients with persistent AF. Patients were then cardioverted and voltage/activation maps were acquired in normal sinus rhythm (NSR). Total left atrium (LA), CFAE and LVE areas were measured as % of total LA area (mean ± SD). Conduction velocities of normal, LVE and CFAE areas were also measured during NSR. Patients underwent signal averaged ECG of the P-wave in NSR within 24 h of the procedure. Complex fractionated atrial electrograms areas accounted for 33 ± 24% of total LA. In NSR, only 12 ± 10% of LA area had LVE. There was no anatomic correlation between CFAE sites and LVE; the area of overlap between CFAE and LVE was only 1.6 ± 1.5%. Conduction velocity was faster in CFAE areas (2.3 ± 1.4 m/s) than in normal voltage areas (1.3 ± 0.3 m/s), and LVE areas (1.1 ± 0.7 m/s, P = 0.06). A positive correlation was only found between LVE areas and SAPW duration (r = 0.7, P = 0.04).
Areas of CFAEs correspond to areas of normal atrial voltage and normal conduction velocity during NSR. Complex fractionated atrial electrogram probably represents the response of normal healthy atrial tissue to rapid pulmonary vein activation.</description><subject>Action Potentials</subject><subject>Aged</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Catheter Ablation</subject><subject>Chi-Square Distribution</subject><subject>Electrocardiography</subject><subject>Electrophysiologic Techniques, Cardiac</subject><subject>Female</subject><subject>Heart Atria - physiopathology</subject><subject>Heart Conduction System - physiopathology</subject><subject>Heart Conduction System - surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>Pulmonary Veins - physiopathology</subject><subject>Pulmonary Veins - surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1099-5129</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kUtPAyEUhYnR-F67MyzdjPIo81ga4ysxcaPrCQOXFsMMIzDV_hd_rNS2rrjkfuec3ByELii5pqThNzAFP0oFeYic0T10TAVnBSMN288zaZpCUNYcoZMYPwghFWvEITpinM5qSutj9HMbQEb8ZdMCK9-PDr6xCVIl6weZQGOZgpUOgwOVgp8H2UccQPmg10uTIOBxcn2mwwovwQ7YRu_kWp-5MUCEIeHBhz67LL1Lcg5YDjqnDXr6y8ky55VNK5zV0Q5TTlis0qI_QwdGugjn2_cUvT_cv909FS-vj893ty-F4rxOhcyHdbrjUujKqHpWkk6opikVrVhV5Q_jtdGqZnxmmNGm4oJ2s7LTQouuLBU_RVcb3zH4zwliansbFTgnB_BTbCmnLHvVTGT0ZoOq4GMMYNox2D7f3lLSritpd5W0m0qy4nJrPnU96H9-1wH_BQ8mj-o</recordid><startdate>201303</startdate><enddate>201303</enddate><creator>Viles-Gonzalez, Juan F</creator><creator>Gomes, J Anthony</creator><creator>Miller, Marc A</creator><creator>Dukkipati, Srinivas R</creator><creator>Koruth, Jacob S</creator><creator>Eggert, Charles</creator><creator>Coffey, James</creator><creator>Reddy, Vivek Y</creator><creator>d'Avila, Andre</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201303</creationdate><title>Areas with complex fractionated atrial electrograms recorded after pulmonary vein isolation represent normal voltage and conduction velocity in sinus rhythm</title><author>Viles-Gonzalez, Juan F ; Gomes, J Anthony ; Miller, Marc A ; Dukkipati, Srinivas R ; Koruth, Jacob S ; Eggert, Charles ; Coffey, James ; Reddy, Vivek Y ; d'Avila, Andre</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c338t-a000bdb3a5d7fc8460b5c996c172770b5238fdc8234f2fdf7351b46bd5d5b66c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Action Potentials</topic><topic>Aged</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Catheter Ablation</topic><topic>Chi-Square Distribution</topic><topic>Electrocardiography</topic><topic>Electrophysiologic Techniques, Cardiac</topic><topic>Female</topic><topic>Heart Atria - physiopathology</topic><topic>Heart Conduction System - physiopathology</topic><topic>Heart Conduction System - surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Predictive Value of Tests</topic><topic>Pulmonary Veins - physiopathology</topic><topic>Pulmonary Veins - surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Viles-Gonzalez, Juan F</creatorcontrib><creatorcontrib>Gomes, J Anthony</creatorcontrib><creatorcontrib>Miller, Marc A</creatorcontrib><creatorcontrib>Dukkipati, Srinivas R</creatorcontrib><creatorcontrib>Koruth, Jacob S</creatorcontrib><creatorcontrib>Eggert, Charles</creatorcontrib><creatorcontrib>Coffey, James</creatorcontrib><creatorcontrib>Reddy, Vivek Y</creatorcontrib><creatorcontrib>d'Avila, Andre</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Viles-Gonzalez, Juan F</au><au>Gomes, J Anthony</au><au>Miller, Marc A</au><au>Dukkipati, Srinivas R</au><au>Koruth, Jacob S</au><au>Eggert, Charles</au><au>Coffey, James</au><au>Reddy, Vivek Y</au><au>d'Avila, Andre</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Areas with complex fractionated atrial electrograms recorded after pulmonary vein isolation represent normal voltage and conduction velocity in sinus rhythm</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2013-03</date><risdate>2013</risdate><volume>15</volume><issue>3</issue><spage>339</spage><epage>346</epage><pages>339-346</pages><issn>1099-5129</issn><eissn>1532-2092</eissn><abstract>Although complex fractionated atrial electrograms (CFAEs) are purported to represent critical sites for atrial fibrillation (AF) perpetuation, the mechanism and the significance of CFAE in the genesis of AF remain poorly understood. This study evaluated the relationship between CFAE and areas of abnormal atrial tissue defined by low-voltage electrograms (LVE) and signal average of the P-wave (SAPW).
Complex fractionated atrial electrogram maps were obtained after pulmonary vein isolation in 15 patients with persistent AF. Patients were then cardioverted and voltage/activation maps were acquired in normal sinus rhythm (NSR). Total left atrium (LA), CFAE and LVE areas were measured as % of total LA area (mean ± SD). Conduction velocities of normal, LVE and CFAE areas were also measured during NSR. Patients underwent signal averaged ECG of the P-wave in NSR within 24 h of the procedure. Complex fractionated atrial electrograms areas accounted for 33 ± 24% of total LA. In NSR, only 12 ± 10% of LA area had LVE. There was no anatomic correlation between CFAE sites and LVE; the area of overlap between CFAE and LVE was only 1.6 ± 1.5%. Conduction velocity was faster in CFAE areas (2.3 ± 1.4 m/s) than in normal voltage areas (1.3 ± 0.3 m/s), and LVE areas (1.1 ± 0.7 m/s, P = 0.06). A positive correlation was only found between LVE areas and SAPW duration (r = 0.7, P = 0.04).
Areas of CFAEs correspond to areas of normal atrial voltage and normal conduction velocity during NSR. Complex fractionated atrial electrogram probably represents the response of normal healthy atrial tissue to rapid pulmonary vein activation.</abstract><cop>England</cop><pmid>23148118</pmid><doi>10.1093/europace/eus321</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Europace (London, England), 2013-03, Vol.15 (3), p.339-346 |
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| source | Oxford Journals Open Access Collection; MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Action Potentials Aged Atrial Fibrillation - diagnosis Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Catheter Ablation Chi-Square Distribution Electrocardiography Electrophysiologic Techniques, Cardiac Female Heart Atria - physiopathology Heart Conduction System - physiopathology Heart Conduction System - surgery Humans Male Middle Aged Predictive Value of Tests Pulmonary Veins - physiopathology Pulmonary Veins - surgery Time Factors Treatment Outcome |
| title | Areas with complex fractionated atrial electrograms recorded after pulmonary vein isolation represent normal voltage and conduction velocity in sinus rhythm |
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