Impact of anisotropic conduction and premature atrial contraction on the fractionated atrial potentials.

Background: Fractionated atrial potential (FAP) during sinus rhythm (SR) may be a new target for ablation of atrial fibrillation (AF). However, the effects of the direction of activation and premature atrial contraction (PAC) on FAP is unknown. Therefore, we examined the impact of anisotropic conduction and PAC on the distribution and areas of FAP.

Methods: FAP map in the left atrium was created in 40 patients with AF before ablation. The distribution and areas of FAP were compared during SR, distal coronary sinus (CS) pacing (S1) and extrastimulus (S2), and paced PAC after SR. FAP was defined as a potential with four or more fragmented deflections.

Results: FAPs during SR were found in the right and mid-anterior walls and septum in most patients. During S1 compared to SR, FAPs significantly decreased in the right and mid-anterior walls, appendage, septum, and right inferior wall, while significantly increased in the lateral wall. During S2 compared to S1, FAPs significantly increased in the mid anterior and right and mid posterior walls. During PAC compared to SR, FAPs significantly decreased in the right and mid anterior walls and roof, while significantly increased in the left anterior, left inferior and lateral walls. A rotational activation pattern at the FAP area during CS pacing was observed in 12 patients (30%), mostly in the left inferior wall.

Conclusions: The distribution and areas of FAP vary with anisotropic conduction and extrastimulus. Therefore, FAP should be evaluated not only during SR but also during extrastimulus from the distal CS.