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How to perform electrogram-guided atrial fibrillation ablation

      Over the past decade, several mapping studies of human atrial fibrillation (AF) have made the following important observations: (1) Atrial electrograms during sustained atrial fibrillation have three distinct patterns: single potential, double potential, and complex fractionated potential(s) (CFAEs).
      • Nademanee K.
      • McKenzie J.
      • Kosar E.
      • Schwab M.
      • Witayakul B.
      • Vasavakul
      • Khunnawat C.
      • Ngarmukos T.
      A new approach for catheter ablation of atrial fibrillation mapping of electrophysiologic substrate.
      • Jais P.
      • Haissaguerre M.
      • Shah D.C.
      • Chouairi S.
      • Clementy J.
      Regional disparities of endocardial atrial activation in paroxysmal atrial fibrillation.
      • Konings K.T.S.
      • Smeets J.L.R.M.
      • Penn O.C.
      • Wellens H.J.
      • Allessie M.A.
      Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans.
      (2) The distribution of these atrial electrograms during AF localizes to specific atrial sites, and these electrograms exhibit remarkable temporal and spatial stability.
      • Nademanee K.
      • McKenzie J.
      • Kosar E.
      • Schwab M.
      • Witayakul B.
      • Vasavakul
      • Khunnawat C.
      • Ngarmukos T.
      A new approach for catheter ablation of atrial fibrillation mapping of electrophysiologic substrate.
      • Jais P.
      • Haissaguerre M.
      • Shah D.C.
      • Chouairi S.
      • Clementy J.
      Regional disparities of endocardial atrial activation in paroxysmal atrial fibrillation.
      (3) The CFAE areas represent AF substrate sites and are important targets for AF ablation.
      • Nademanee K.
      • McKenzie J.
      • Kosar E.
      • Schwab M.
      • Witayakul B.
      • Vasavakul
      • Khunnawat C.
      • Ngarmukos T.
      A new approach for catheter ablation of atrial fibrillation mapping of electrophysiologic substrate.
      • Jais P.
      • Haissaguerre M.
      • Shah D.C.
      • Chouairi S.
      • Clementy J.
      Regional disparities of endocardial atrial activation in paroxysmal atrial fibrillation.
      • Konings K.T.S.
      • Smeets J.L.R.M.
      • Penn O.C.
      • Wellens H.J.
      • Allessie M.A.
      Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans.
      • Quan K.J.
      • Lee J.H.
      • Van Hare G.F.
      • Biblo L.A.
      • Mackall J.A.
      • Carlson M.D.
      Identification and characterization of atrioventricular parasympathetic innervation in humans.
      • Scherlag B.J.
      • Nakagawa H.
      • Jackman W.M.
      • Yamanashi
      • Patterson E.
      • Po S.
      • Lazzara R.
      Electrical stimulation to identify neural elements on the heart their role in atrial fibrillation.
      By ablating such areas that have persistent CFAEs, one eliminates AF and usually renders AF noninducible. With this observation, CFAE mapping has become a novel approach for guiding successful AF substrate ablation with excellent long-term outcomes.
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      References

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        A new approach for catheter ablation of atrial fibrillation.
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        Regional disparities of endocardial atrial activation in paroxysmal atrial fibrillation.
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        Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans.
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