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Hands on| Volume 3, ISSUE 8, P981-984, August 2006

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How to perform electrogram-guided atrial fibrillation ablation

Published:March 24, 2006DOI:https://doi.org/10.1016/j.hrthm.2006.03.018
How to perform electrogram-guided atrial fibrillation ablation
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      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.
      J Am Coll Cardiol. 2004; 43: 2044-2053
      , 
      • Jais P.
      • Haissaguerre M.
      • Shah D.C.
      • Chouairi S.
      • Clementy J.
      Regional disparities of endocardial atrial activation in paroxysmal atrial fibrillation.
      Pacing Clin Electrophysiol. 1996; 19: 1998-2003
      , 
      • 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.
      Circulation. 1997; 95: 1231-1241
      (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.
      J Am Coll Cardiol. 2004; 43: 2044-2053
      , 
      • Jais P.
      • Haissaguerre M.
      • Shah D.C.
      • Chouairi S.
      • Clementy J.
      Regional disparities of endocardial atrial activation in paroxysmal atrial fibrillation.
      Pacing Clin Electrophysiol. 1996; 19: 1998-2003
      (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.
      J Am Coll Cardiol. 2004; 43: 2044-2053
      , 
      • Jais P.
      • Haissaguerre M.
      • Shah D.C.
      • Chouairi S.
      • Clementy J.
      Regional disparities of endocardial atrial activation in paroxysmal atrial fibrillation.
      Pacing Clin Electrophysiol. 1996; 19: 1998-2003
      , 
      • 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.
      Circulation. 1997; 95: 1231-1241
      , 
      • 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.
      J Cardiovasc Electrophysiol. 2002; 13: 735-739
      , 
      • 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.
      J Interv Cardiac Electrophysiol. 2005; 13: 37-42
      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

        • Nademanee K.
        • McKenzie J.
        • Kosar E.
        • Schwab M.
        • Witayakul B.
        • Vasavakul
        • Khunnawat C.
        • Ngarmukos T.
        A new approach for catheter ablation of atrial fibrillation.
        J Am Coll Cardiol. 2004; 43: 2044-2053
        View in Article
        • Jais P.
        • Haissaguerre M.
        • Shah D.C.
        • Chouairi S.
        • Clementy J.
        Regional disparities of endocardial atrial activation in paroxysmal atrial fibrillation.
        Pacing Clin Electrophysiol. 1996; 19: 1998-2003
        View in Article
        • 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.
        Circulation. 1997; 95: 1231-1241
        View in Article
        • 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.
        J Cardiovasc Electrophysiol. 2002; 13: 735-739
        View in Article
        • Scherlag B.J.
        • Nakagawa H.
        • Jackman W.M.
        • Yamanashi
        • Patterson E.
        • Po S.
        • Lazzara R.
        Electrical stimulation to identify neural elements on the heart.
        J Interv Cardiac Electrophysiol. 2005; 13: 37-42
        View in Article

      Article info

      Publication history

      Published online: March 24, 2006

      Identification

      DOI: https://doi.org/10.1016/j.hrthm.2006.03.018

      Copyright

      © 2006 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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