Spatial and Temporal Stability of Complex Fractionated Electrograms in Patients with Persistent Atrial Fibrillation over Longer Time Periods: Relationship to Local Electrogram Cycle Length

Verma, Atul; Wulffhart, Zaev; Beardsall, Marianne; Whaley, Bonnie; Hill, Carol; Khaykin, Yaariv

doi:10.1016/j.hrthm.2008.04.027

Cited by 37 publications

(46 citation statements)

References 14 publications

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“…However there are now multiple algorithms available for identifying these CFAE sites and how they are identified varies. There has been demonstration that these can vary over time and are affected by ablation in other areas, for example, during PVA/PVI [29].…”

Section: Complex Fractionated Atrial Electrogram Ablationmentioning

confidence: 99%

Catheter Ablation of Persistent Atrial Fibrillation

Rajappan

Ginks

2014

Future Cardiol.

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Catheter ablation of atrial fibrillation (AF) is performed increasingly worldwide and with the development of new technologies the procedures have become safer and more effective after a single attempt, particularly with paroxysmal AF. However, success rates for persistent AF ablation remain far lower than paroxysmal AF and there is large variation in the strategies used worldwide. This review describes the background to persistent AF ablation, the different strategies used and their associated risks and benefits, developing technologies and the authors' perspective on the future of this rapidly evolving area.

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Section: Complex Fractionated Atrial Electrogram Ablationmentioning

confidence: 99%

Catheter Ablation of Persistent Atrial Fibrillation

Rajappan

Ginks

2014

Future Cardiol.

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“…On the other hand, sinus rhythm fractionation mainly occurs at sites of wave-front collisions which are similarly distributed in patients with and without AF, and these sites can be varied by coronary sinus pacing. Temporal and spatial stability of CFAE sites during AF is reported to be high [140, 141]. This can be explained by the fact that CFAEs mostly occur at sites of tissue heterogeneity, where cycle length shortening will repeatedly lead to CFAE formation.…”

Section: Persistent Af Ablation Challenge One: Cfaesmentioning

confidence: 99%

Current Hot Potatoes in Atrial Fibrillation Ablation

Roten

Derval²,

Pascale³

et al. 2012

CCR

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Atrial fibrillation (AF) ablation has evolved to the treatment of choice for patients with drug-resistant and symptomatic AF. Pulmonary vein isolation at the ostial or antral level usually is sufficient for treatment of true paroxysmal AF. For persistent AF ablation, drivers and perpetuators outside of the pulmonary veins are responsible for AF maintenance and have to be targeted to achieve satisfying arrhythmia-free success rate. Both complex fractionated atrial electrogram (CFAE) ablation and linear ablation are added to pulmonary vein isolation for persistent AF ablation. Nevertheless, ablation failure and necessity of repeat ablations are still frequent, especially after persistent AF ablation. Pulmonary vein reconduction is the main reason for arrhythmia recurrence after paroxysmal and to a lesser extent after persistent AF ablation. Failure of persistent AF ablation mostly is a consequence of inadequate trigger ablation, substrate modification or incompletely ablated or reconducting linear lesions. In this review we will discuss these points responsible for AF recurrence after ablation and review current possibilities on how to overcome these limitations.

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“…CFAEs have demonstrated remarkable spatial and temporal stability in studies using the automated CFAE detection algorithms provided by both CARTO (Biosense-Webster, Baldwin Park, CA, USA) [8,9] and NavX (St. Jude Medical, Inc., St. Paul, MN, USA) [10,11] mapping systems. Indeed, CFAE maps can even be reproduced during two distinct and separate episodes of AF [12].…”

Section: Complex Fractionated Atrial Electrogramsmentioning

confidence: 99%

“…Indeed, CFAE maps can even be reproduced during two distinct and separate episodes of AF [12]. Within a single episode of AF and between two episodes of AF, greater spatiotemporal stability has been observed for CFAEs with shorter cycle lengths (≤120 ms) [11,12]. Areas most often harboring CFAEs include the interatrial septum, pulmonary veins, left atrial roof, left atrial appendage, coronary sinus ostium and crista terminalis [5,6,[8][9][10]12,13].…”

Section: Complex Fractionated Atrial Electrogramsmentioning

confidence: 99%

“…Given the high prevalence of CFAEs in PeAF (37-52% of left atrial endocardial surface area) [10][11][12][13][14]19], an extensive CFAE-guided ablation strategy may be unnecessarily associated with long procedure duration, considerable radiation exposure, potential collateral damage, and impaired left atrial contractile function. As a result, there is high demand for a mapping strategy that reliably distinguishes between active/driver CFAE sites and passive/bystander CFAE sites.…”

Section: Complex Fractionated Atrial Electrogramsmentioning

confidence: 99%

See 1 more Smart Citation

Mapping of Atrial Fibrillation: Comparing Complex Fractionated Atrial Electrograms, Voltage Maps, Dominant Frequency Maps and Ganglionic Plexi

Al‐Ahmad

Schoenhard

2012

Cardiac Mapping

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Catheter-based radio-frequency ablation is an effective therapy for controlling atrial fibrillation (AF) in appropriately selected patients. While anatomic pulmonary vein isolation is typically sufficient for individuals with paroxysmal AF, adjunctive substrate modification within the body of the left atrium is often necessary in individuals with persistant AF. Several cardiac mapping strategies can be used to accurately target ablation for improved efficacy and limit unnecessary ablation for improved safety. These include identification of complex fractionated atrial electrograms, measurement of voltage in sinus rhythm and AF, assessment of dominant frequency and localization of ganglionic plexi. This chapter will compare these overlapping methodologies and provide recommendations with regard to their utilization.

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Spatial and Temporal Stability of Complex Fractionated Electrograms in Patients with Persistent Atrial Fibrillation over Longer Time Periods: Relationship to Local Electrogram Cycle Length

Cited by 37 publications

References 14 publications

Catheter Ablation of Persistent Atrial Fibrillation

Catheter Ablation of Persistent Atrial Fibrillation

Current Hot Potatoes in Atrial Fibrillation Ablation

Mapping of Atrial Fibrillation: Comparing Complex Fractionated Atrial Electrograms, Voltage Maps, Dominant Frequency Maps and Ganglionic Plexi

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