| 장진근, 박재석,김용현,최종일,신승용,김지훈,주형준,임홍의,박희남,김영훈 |
It remains to be determined whether the sites showing complex fractionated atrial electrogram (CFAE) during atrial fibrillation (AF) are closely related to those registered dominant frequency (DF) obtaining by frequency spectrum. We hypothesized that co-localized sites of CFAE and high value of DF indicate a rapidly firing focus in AF, in contrast, sites of CFAE without accompanying DF demonstrate bystander-fibrillatory conduction. We explored the spatial relationship of CFAE with the highest DF and arrhythmogenic foci.
Methods Eleven patients [6 paroxysmal AF (PAF), 49±8 yrs old, and 5 chronic AF (CAF), 55±11 yrs old] whose arrhythmogenic foci were reproducibly identified, were included. Color coded CFAE (≤120 ms) map and DF map during AF were generated by contact bipolar electrogram (70~100 points) in the left atrium (LA) and pulmonary veins (PV) obtained during 6 sec-segment of AF using NavX system. CFAE and DF maps were divided into 16 areas (4 quadrants and 4 PVs in anterior posterior view and posterior anterior view, respectively), and each area was classified whether arrhythmogenic focus was included. Results: 1. The mean highest DF in PAF(17.5±1.6 Hz) was higher than in CAF(15.9±2.62Hz). 2. Arrhythmogenic focus matched with the sites co-localized CFAE and DF in all PAF and CAF patients. 3. CFAE was also noted at the interatrial septum in 91%, however, DF did not correspond to CFAE in 3 (27%) patients. 4. The number of DF sites (3.8±0.7) was slightly higher than that of CFAE (3.4±0.8, NS) and each was higher in PAF (DF:4.2±0.7, CFAE:3.8±0.8) than in CAF (DF:3.4±0.8, CFAE:3.0±1.0).
Conclusions Co-localized site of CFAE and the highest DF indicated arrhythmogenic foci in patients with focally-initiated PAF and CAF, however, the sites with CFAE not perfectly matched with the highest DF, such as interatrial septum, were more likely due to bystander fibrillatory conduction. Further study is required to clarify whether the incorporation of CFE map and DF analysis enhances to reveal underlying mechanisms of AF and guide more effective therapy.
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