The temporal variability of dominant frequency and complex fractionated atrial electrograms constrains the validity of sequential mapping in human atrial fibrillation

Habel, Nicole; Znojkiewicz, Pierre; Thompson, Nathaniel; Müller, Joachim G.; Mason, Bryan; Calame, James; Calame, Susan; Sharma, SK; Mirchandani, G.; Janks, Deborah; Bates, Jason H. T.; Noori, Arshia; Karnbach, Andreas; Lustgarten, Daniel L.; Sobel, Burton E.; Spector, Peter

doi:10.1016/j.hrthm.2010.01.010

Cited by 70 publications

(73 citation statements)

References 17 publications

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“…30 However, a consensus definition of CFAEs and which type of electrograms should be ablated are yet to be defined. Similarly, there is evidence that CFAEs may vary temporally and spatially, 31 and the timeframe over which CFAEs should be acquired is not defined and varies between studies. The type of catheters used and the contact force used is also variable without a standardized approach.…”

Section: Why Is Cfae Ablation Of No Benefit?mentioning

confidence: 99%

Is There Still a Role for Complex Fractionated Atrial Electrogram Ablation in Addition to Pulmonary Vein Isolation in Patients With Paroxysmal and Persistent Atrial Fibrillation?

Providência

Lambiase

Srinivasan

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-Ablation of complex fractionated atrial electrograms (CFAEs) has been proposed as a strategy to improve outcomes in atrial fibrillation (AF) catheter ablation, but the use of this technique remains contentious. We aimed to assess the impact of CFAE ablation in addition to pulmonary vein isolation (PVI) in patients undergoing ablation for AF. Methods and Results-We performed a random effects meta-analysis of studies comparing PVI versus PVI+CFAE ablation.The outcomes of freedom from AF/atrial tachycardia after 1 or several ablation procedures and acute procedural-related complications were assessed. Studies were searched on MEDLINE, EMBASE, COCHRANE, and clinicaltrials.gov, and sensitivity analyses were performed. Thirteen studies including a total of 1415 patients were considered eligible.

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Section: Why Is Cfae Ablation Of No Benefit?mentioning

confidence: 99%

Is There Still a Role for Complex Fractionated Atrial Electrogram Ablation in Addition to Pulmonary Vein Isolation in Patients With Paroxysmal and Persistent Atrial Fibrillation?

Providência

Lambiase

Srinivasan

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…Therefore, the temporal instability observed in DF maps 33 is not explained by differences in mapping CF.…”

Section: Catheter Contact and Spectral Analysis Parametersmentioning

confidence: 91%

Impact of Catheter Contact Force on Human Left Atrial Electrogram Characteristics in Sinus Rhythm and Atrial Fibrillation

Ullah

Hunter

Baker

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-During left atrial mapping, optimal contact parameters minimizing variation secondary to catheter contact are not established. Methods and Results-Across 30 patients undergoing first-time atrial fibrillation ablation, 1965 stable mapping points (1409 atrial fibrillation, 556 sinus rhythm), comprising 8-s contact force (CF) and bipolar electrogram data were analyzed. Points were taken in groups at locations with CF or catheter orientation actively changed between acquisitions. Complexes were less positive at higher CF (Spearman ρ, −0.2; P<0.005, both rhythms). Increasing CF at a location significantly increased complex size, but only where initial CF was <10 g, and if the change was ≥4.5 g in sinus rhythm and ≥8 g in atrial fibrillation (P<0.0005, both rhythms): if initial CF was ≥10 g, no change was observed, regardless of CF change (P>0.05, both). Atrial ectopics during sinus rhythm were observed more frequently when CF was ≥10 g (P<0.0005). Increasing CF at a location was associated with an increase in the complex fractionated atrial electrogram interval confidence level score, but only if initial CF was <10 g and CF increased ≥8 g (P=0.003). The dominant frequency and organization index were unaffected by CF (P>0.1 for both). Changing catheter orientation from perpendicular to parallel in atrial fibrillation was associated with smaller, more positive complexes (P=0.001 for both), but no changes in complex fractionated atrial electrogram scores, dominant frequency or organization index (P>0.08 for each). Conclusions-During left atrial electrogram mapping, including complex fractionated atrial electrogram but not spectral parameter mapping, CF and catheter orientation influence results: consequently, mapping CFs should be ≥10 g to negate the influence of CF. Clinical Trials Registration

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“…Beside this major limitation, other challenges with CFAE include their relative subjectivity if assessed visually, the temporal and spatial variability despite the use of automated mapping algorithms [35], and the presence of some far-field signal among CFAEs [36]. Improved discrimination among the CFAE sites in the future may allow for more selective radio-frequency application and reduction of the extent of ablation.…”

Section: Complex Fragmented Atrial Electrograms (Figure 312)mentioning

confidence: 99%

Mapping of Persistent Atrial Fibrillation: How Many Sites, How Many Lines?

et al. 2012

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The temporal variability of dominant frequency and complex fractionated atrial electrograms constrains the validity of sequential mapping in human atrial fibrillation

Cited by 70 publications

References 17 publications

Is There Still a Role for Complex Fractionated Atrial Electrogram Ablation in Addition to Pulmonary Vein Isolation in Patients With Paroxysmal and Persistent Atrial Fibrillation?

Is There Still a Role for Complex Fractionated Atrial Electrogram Ablation in Addition to Pulmonary Vein Isolation in Patients With Paroxysmal and Persistent Atrial Fibrillation?

Impact of Catheter Contact Force on Human Left Atrial Electrogram Characteristics in Sinus Rhythm and Atrial Fibrillation

Mapping of Persistent Atrial Fibrillation: How Many Sites, How Many Lines?

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