Characteristics and Distribution of Complex Fractionated Atrial Electrograms and Dominant Frequency during Atrial Fibrillation in Patients Responding or Non-Responding to Pulmonary Vein Isolation

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Background: Substrate-based radiofrequency ablation of atrial fibrillation (AF) is still under development. We investigated the characteristics of complex fractionated atrial electrograms (CFAE) and the dominant frequency (DF) in AF patients. Methods: BARD Lab systems were used to map the left and right atria and the coronary sinus in 28 AF patients (non-paroxysmal=9). Automated algorithms calculated the average time interval between CFAE and the DF by a fast Fourier transform analysis during AF. Results: In 11 patients in whom pulmonary vein (PV) isolation terminated AF, there was a high DF in the culprit PV (8.3±1.7 Hz) and a significant DF gradient from the PV to the left atrial (LA) body (2.4±1.4 Hz), and the CFAE sites were mainly located at the PV antrum. In the remaining 17 patients who did not respond to PVI, a high DF was located in the PVs (7.8±0.8 Hz), but the DF gradient was less than that in the PVI group (1.2±0.8 Hz, p=0.005 vs. PVI group) and the CFAE sites extended to the LA body. Conclusions: In the PVI non-responders, the PV-LA DF gradient was smaller, and the CFAEs were distributed in the LA body as compared to the PVI responders.