Relationship between Complex Fractionated Electrogram Influenced by Antiarrhythmogenic Agents and Atrial Substrate

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Introduction: Complex fractionated electrogram (CFE) can identify target sites for ablation of atrial fibrillation (AF). The influence of the anti-arrhythmic agents (AAA) for CFE is not completely recognized. We investigated CFE and modified CFE with AAA by a multiple simultaneous CFE recording. Methods: A total of 13 patients (10 male, 62±8 years) of non-paroxysmal AF were enrolled. We placed a 64-electrode basket catheter in the left atrium (LA) and recorded LA electrograms with serial rapid mapping technique. CFE was recorded and defined according to the algorithm of the mapping (NavX®) system (CFE; atrial electrogram cycle length of <50 ms over 5 seconds duration). After a control recording of the CFE, intravenous flecainide of 2 mg/kg was given. CFE was stored in NavX at 5, 10, and 15 minutes. In this study, we compared the changes of the distribution of the CFE and the bipolor voltage during AF. Results: The CFE area and the number of CFE regions were significantly reduced at 5 minutes after the flecainide infusion. The area of continuous CFE region almost recovered by 15 minutes. The mean voltage of modified CFE regions was significantly lower than that of continuous CFE regions (0.89±0.51 mV vs 0.54±0.29 mV, p<0.001). Conclusions: CFE eliminated with AAA might have more important meaning as a substrate of AF.