Comparative distribution of complex fractionated atrial electrograms, high dominant frequency (HDF) sites during atrial fibrillation and HDF sites during sinus rhythm.

Purpose: Complex fractionated atrial electrograms (CFAEs) and high dominant frequency sites during atrial fibrillation (AF-HDF) are related to the maintenance of atrial fibrillation (AF). HDF sites in sinus rhythm (SR-HDF; as defined by frequencies of >70 Hz) are suggested to be abnormal atrial tissue. Relations between these electrophysiologic signals have not been elucidated.

Methods: We investigated the relations between SR-HDF and CFAE and AF-HDF sites during AF. NavX-based maps of CFAE and left atrium (LA)/pulmonary vein (PV) dominant frequency (DF) during AF and DF maps during SR were created for 23 patients with AF (paroxysmal AF (PAF), n = 14; persistent AF (PerAF), n = 9).

Results: The extent of overlap between SR-HDF and CFAE sites was 51 ± 18 % (as calculated by the LA/PV segments containing both an SR-HDF site and a CFAE site/total LA/PV segments containing an CFAE site) and the extent of overlap between SR-HDF and AF-HDF sites was 50 ± 35 % (P = 0.7464). However, statistically poor agreement was noted for both (kappa values, 0.07 ± 0.19 and 0.08 ± 0.24, P = 0.8794). The extent of overlap did not differ between PAF and PerAF patients (SR-HDF and CFAE, 52 % (interquartile range (IQR), 42-59) versus 57 % (IQR, 33-67), P = 0.5842; SR-HDF and AF-HDF, 43 % (IQR, 25-85) versus 55 % (IQR, 13-83), P = 0.9465). The bipolar voltage amplitudes of SR-HDF, CFAE, and AF-HDF sites revealed normal voltage areas (1.6 mV (IQR, 0.8-2.7), 1.9 mV (IQR, 1.1-2.8), and 1.5 mV (IQR, 1.7-2.7), respectively).

Conclusions: In both PAF and PerAF, most CFAE and AF-HDF sites did not correspond to the SR-HDF sites or low-voltage area during SR. Thus, most CFAE and DF signals during AF represent functional electrical activities rather than structural remodeling of the atria.