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Erschienen in: Heart and Vessels 5/2016

09.04.2015 | Original Article

Left atrial electrophysiologic feature specific for the genesis of complex fractionated atrial electrogram during atrial fibrillation

verfasst von: Tadashi Hoshiyama, Hiroshige Yamabe, Junjiroh Koyama, Hisanori Kanazawa, Hisao Ogawa

Erschienen in: Heart and Vessels | Ausgabe 5/2016

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Abstract

Complex fractionated atrial electrogram (CFAE) has been suggested to contribute to the maintenance of atrial fibrillation (AF). However, electrophysiologic characteristics of the left atrial myocardium responsible for genesis of CFAE have not been clarified. Non-contact mapping of the left atrium was performed at 37 AF onset episodes in 24 AF patients. Electrogram amplitude, width, and conduction velocity were measured during sinus rhythm, premature atrial contraction (PAC) with long- (L-PAC), short- (S-PAC) and very short-coupling intervals (VS-PAC). These parameters were compared between CFAE and non-CFAE regions. Unipolar electrogram amplitude was higher in CFAE than non-CFAE during sinus rhythm, L-, S- and VS-PAC (1.82 ± 0.73 vs. 1.13 ± 0.38, p < 0.001; 1.44 ± 0.54 vs. 0.92 ± 0.35, p < 0.001; 1.09 ± 0.40 vs. 0.70 ± 0.27, p < 0.001; 0.76 ± 0.30 vs. 0.53 ± 0.25 mV, p < 0.001). Laplacian bipolar electrogram amplitude was also higher in CFAE than non-CFAE during sinus rhythm, L-, S- and VS-PAC. Unipolar electrogram width was similar in CFAE and non-CFAE. Laplacian bipolar electrogram width was wider in CFAE than non-CFAE during L-, S- and VS-PAC (85.5 ± 6.8 vs. 79.6 ± 4.5, p < 0.001; 96.1 ± 9.7 vs. 84.5 ± 5.9, p < 0.001; 122.4 ± 16.0 vs. 99.6 ± 9.6 ms, p < 0.001), but not during sinus rhythm. The conduction velocity was slower in CFAE during sinus rhythm, L-, S- and VS-PAC than non-CFAE (1.7 ± 0.3 vs. 2.4 ± 0.4, p < 0.001; 1.4 ± 0.3 vs. 2.0 ± 0.5, p < 0.001; 1.2 ± 0.3 vs. 1.7 ± 0.5, p < 0.001; and 0.9 ± 0.3 vs. 1.4 ± 0.4 m/s, p < 0.001). CFAE was generated in the high amplitude atrial myocardium with slow and non-uniform conduction properties which were pronounced associated with premature activation, suggesting that heterogeneous conduction produced in high amplitude region contributes to the genesis of CFAE.
Literatur
1.
Zurück zum Zitat Hayward RM, Upadhyay GA, Mela T, Ellinor PT, Barrett CD, Heist EK, Verma A, Choudhry NK, Singh JP (2011) Pulmonary vein isolation with complex fractionated atrial electrogram ablation for paroxysmal and nonparoxysmal atrial fibrillation: a meta-analysis. Heart Rhythm 8:994–1000CrossRefPubMedPubMedCentral Hayward RM, Upadhyay GA, Mela T, Ellinor PT, Barrett CD, Heist EK, Verma A, Choudhry NK, Singh JP (2011) Pulmonary vein isolation with complex fractionated atrial electrogram ablation for paroxysmal and nonparoxysmal atrial fibrillation: a meta-analysis. Heart Rhythm 8:994–1000CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Nademanee K, Lockwood E, Oketani N, Gidney B (2010) Catheter ablation of atrial fibrillation guided by complex fractionated atrial electrogram mapping of atrial fibrillation substrate. J Cardiol 55:1–12CrossRefPubMed Nademanee K, Lockwood E, Oketani N, Gidney B (2010) Catheter ablation of atrial fibrillation guided by complex fractionated atrial electrogram mapping of atrial fibrillation substrate. J Cardiol 55:1–12CrossRefPubMed
3.
Zurück zum Zitat Konings KT, Smeets JL, Penn OC, Wellens HJ, Allessie MA (1997) Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans. Circulation 95:1231–1241CrossRefPubMed Konings KT, Smeets JL, Penn OC, Wellens HJ, Allessie MA (1997) Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans. Circulation 95:1231–1241CrossRefPubMed
4.
Zurück zum Zitat Nademanee K, McKenzie J, Kosar E, Schwab M, Sunsaneewitayakul B, Vasavakul T, Khunnawat C, Nagarmukos T (2004) A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol 43:2044–2053CrossRefPubMed Nademanee K, McKenzie J, Kosar E, Schwab M, Sunsaneewitayakul B, Vasavakul T, Khunnawat C, Nagarmukos T (2004) A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol 43:2044–2053CrossRefPubMed
5.
Zurück zum Zitat Yamabe H, Morihisa K, Tanaka Y, Uemura T, Enomoto K, Kawano H, Ogawa H (2009) Mechanisms of the maintenance of atrial fibrillation: role of the complex fractionated atrial electrogram assessed by noncontact mapping. Heart Rhythm 6:1120–1128CrossRefPubMed Yamabe H, Morihisa K, Tanaka Y, Uemura T, Enomoto K, Kawano H, Ogawa H (2009) Mechanisms of the maintenance of atrial fibrillation: role of the complex fractionated atrial electrogram assessed by noncontact mapping. Heart Rhythm 6:1120–1128CrossRefPubMed
6.
Zurück zum Zitat Yamabe H, Morihisa K, Koyama J, Enomoto K, Kanazawa H, Ogawa H (2011) Analysis of the mechanisms initiating random wave propagation at the onset of atrial fibrillation using noncontact mapping: role of complex fractionated electrogram region. Heart Rhythm 8:1228–1236CrossRefPubMed Yamabe H, Morihisa K, Koyama J, Enomoto K, Kanazawa H, Ogawa H (2011) Analysis of the mechanisms initiating random wave propagation at the onset of atrial fibrillation using noncontact mapping: role of complex fractionated electrogram region. Heart Rhythm 8:1228–1236CrossRefPubMed
7.
Zurück zum Zitat Scherr D, Dalal D, Cheema A, Nazarian S, Almasry I, Bilchick K, Cheng A, Henrikson CA, Spragg D, Marine JE, Berger RD, Calkins H, Dong J (2009) Long- and short-term temporal stability of complex fractionated atrial electrograms in human left atrium during atrial fibrillation. J Cardiovasc Electrophysiol 20:13–21CrossRefPubMed Scherr D, Dalal D, Cheema A, Nazarian S, Almasry I, Bilchick K, Cheng A, Henrikson CA, Spragg D, Marine JE, Berger RD, Calkins H, Dong J (2009) Long- and short-term temporal stability of complex fractionated atrial electrograms in human left atrium during atrial fibrillation. J Cardiovasc Electrophysiol 20:13–21CrossRefPubMed
8.
Zurück zum Zitat Beinart R, Abbara S, Blum A, Ferencik M, Heist K, Ruskin J, Mansour M (2011) Left atrial wall thickness variability measured by CT scans in patients undergoing pulmonary vein isolation. J Cardiovasc Electrophysiol 22:1232–1236CrossRefPubMed Beinart R, Abbara S, Blum A, Ferencik M, Heist K, Ruskin J, Mansour M (2011) Left atrial wall thickness variability measured by CT scans in patients undergoing pulmonary vein isolation. J Cardiovasc Electrophysiol 22:1232–1236CrossRefPubMed
9.
Zurück zum Zitat MacAlpine WA (1975) Heart and coronary arteries: an anatomical atlas for clinical diagnosis, radiological investigation, and surgical treatment. Springer, Berlin, pp 58–59CrossRef MacAlpine WA (1975) Heart and coronary arteries: an anatomical atlas for clinical diagnosis, radiological investigation, and surgical treatment. Springer, Berlin, pp 58–59CrossRef
10.
Zurück zum Zitat Ho SY, Sanchez-Quintana D, Cabrera JA, Anderson RH (1999) Anatomy of the left atrium: implications for radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol 10:1525–1533CrossRefPubMed Ho SY, Sanchez-Quintana D, Cabrera JA, Anderson RH (1999) Anatomy of the left atrium: implications for radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol 10:1525–1533CrossRefPubMed
11.
Zurück zum Zitat Suenari K, Nakano Y, Hirai Y, Ogi H, Oda N, Makita Y, Ueda S, Kajihara K, Tokuyama T, Motoda C, Fujiwara M, Chayama K, Kihara Y (2013) Left atrial thickness under the catheter ablation lines in patients with paroxysmal atrial fibrillation: insights from 64-slice multidetector computed tomography. Heart Vessels 28:360–368CrossRefPubMed Suenari K, Nakano Y, Hirai Y, Ogi H, Oda N, Makita Y, Ueda S, Kajihara K, Tokuyama T, Motoda C, Fujiwara M, Chayama K, Kihara Y (2013) Left atrial thickness under the catheter ablation lines in patients with paroxysmal atrial fibrillation: insights from 64-slice multidetector computed tomography. Heart Vessels 28:360–368CrossRefPubMed
12.
Zurück zum Zitat Ho SY, Anderson RH, Sanchez-Quintana D (2002) Atrial structure and fibres: morphologic bases of atrial conduction. Cardiovasc Res 54:325–336CrossRefPubMed Ho SY, Anderson RH, Sanchez-Quintana D (2002) Atrial structure and fibres: morphologic bases of atrial conduction. Cardiovasc Res 54:325–336CrossRefPubMed
13.
Zurück zum Zitat López-Candales A, Grewal H, Katz W (2005) The importance of increased interatrial septal thickness in patients with atrial fibrillation: a transesophageal echocardiographic study. Echocardiography 22:408–414CrossRefPubMed López-Candales A, Grewal H, Katz W (2005) The importance of increased interatrial septal thickness in patients with atrial fibrillation: a transesophageal echocardiographic study. Echocardiography 22:408–414CrossRefPubMed
14.
Zurück zum Zitat Platonov PG, Mitrofanova L, Ivanov V, Ho SY (2008) Substrates for intra-atrial and interatrial conduction in the atrial septum: anatomical study on 84 human hearts. Heart Rhythm 5:1189–1195CrossRefPubMed Platonov PG, Mitrofanova L, Ivanov V, Ho SY (2008) Substrates for intra-atrial and interatrial conduction in the atrial septum: anatomical study on 84 human hearts. Heart Rhythm 5:1189–1195CrossRefPubMed
15.
Zurück zum Zitat Issa ZF, Miller JM, Zipes DP (2012) A companion to Braunwald’s heart disease, 2nd edn. WB Saunders, Philadelphia, pp 72–73 Issa ZF, Miller JM, Zipes DP (2012) A companion to Braunwald’s heart disease, 2nd edn. WB Saunders, Philadelphia, pp 72–73
16.
Zurück zum Zitat Spach MS, Barr RC, Serwer GA, Kootsey JM, Johnson EA (1972) Extracellular potentials related to intracellular action potentials in the dog Purkinje system. Circ Res 5:505–519CrossRef Spach MS, Barr RC, Serwer GA, Kootsey JM, Johnson EA (1972) Extracellular potentials related to intracellular action potentials in the dog Purkinje system. Circ Res 5:505–519CrossRef
17.
Zurück zum Zitat Maeno K, Kasai T, Kasagi S, Kawana F, Ishiwata S, Ohno M, Yamaguchi T, Narui K (2013) Relationship between atrial conduction delay and obstructive sleep apnea. Heart Vessels 28:639–645CrossRefPubMed Maeno K, Kasai T, Kasagi S, Kawana F, Ishiwata S, Ohno M, Yamaguchi T, Narui K (2013) Relationship between atrial conduction delay and obstructive sleep apnea. Heart Vessels 28:639–645CrossRefPubMed
18.
Zurück zum Zitat Sasaki T, Miller CF, Hansford R, Yang J, Caffo BS, Zviman MM, Henrikson CA, Marine JE, Spragg D, Cheng A, Tandri H, Sinha S, Kolandaivelu A, Zimmerman SL, Bluemke DA, Tomaselli GF, Berger RD, Calkins H, Halperin HR, Nazarian S (2012) Myocardial structural associations with local electrograms: a study of postinfarct ventricular tachycardia pathophysiology and magnetic resonance-based noninvasive mapping. Circ Arrhythm Electrophysiol 5:1081–1090CrossRefPubMedPubMedCentral Sasaki T, Miller CF, Hansford R, Yang J, Caffo BS, Zviman MM, Henrikson CA, Marine JE, Spragg D, Cheng A, Tandri H, Sinha S, Kolandaivelu A, Zimmerman SL, Bluemke DA, Tomaselli GF, Berger RD, Calkins H, Halperin HR, Nazarian S (2012) Myocardial structural associations with local electrograms: a study of postinfarct ventricular tachycardia pathophysiology and magnetic resonance-based noninvasive mapping. Circ Arrhythm Electrophysiol 5:1081–1090CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Marrouche NF, Natale A, Wazni OM, Cheng J, Yang Y, Pollack H, Verma A, Ursell P, Scheinman MM (2004) Left septal atrial flutter: electrophysiology, anatomy, and results of ablation. Circulation 109:2440–2447CrossRefPubMed Marrouche NF, Natale A, Wazni OM, Cheng J, Yang Y, Pollack H, Verma A, Ursell P, Scheinman MM (2004) Left septal atrial flutter: electrophysiology, anatomy, and results of ablation. Circulation 109:2440–2447CrossRefPubMed
20.
Zurück zum Zitat Tagawa M, Higuchi K, Chinushi M, Washizuka T, Ushiki T, Ishihara N, Aizawa Y (2001) Myocardium extending from the left atrium onto the pulmonary veins: a comparison between subjects with and without atrial fibrillation. Pacing Clin Electrophysiol 24:1459–1463CrossRefPubMed Tagawa M, Higuchi K, Chinushi M, Washizuka T, Ushiki T, Ishihara N, Aizawa Y (2001) Myocardium extending from the left atrium onto the pulmonary veins: a comparison between subjects with and without atrial fibrillation. Pacing Clin Electrophysiol 24:1459–1463CrossRefPubMed
21.
Zurück zum Zitat Spach MS, Miller WT 3rd, Dolber PC, Kootsey JM, Sommer JR, Mosher CE Jr (1982) The functional role of structural complexities in the propagation of depolarization in the atrium of the dog. Cardiac conduction disturbances due to discontinuities of effective axial resistivity. Circ Res 50:175–191CrossRefPubMed Spach MS, Miller WT 3rd, Dolber PC, Kootsey JM, Sommer JR, Mosher CE Jr (1982) The functional role of structural complexities in the propagation of depolarization in the atrium of the dog. Cardiac conduction disturbances due to discontinuities of effective axial resistivity. Circ Res 50:175–191CrossRefPubMed
22.
Zurück zum Zitat Spach MS, Dolber PC (1986) Relating extracellular potentials and their derivatives to anisotropic propagation at a microscopic level in human cardiac muscle. Evidence for electrical uncoupling of side-to-side fiber connections with increasing age. Circ Res 58:356–371CrossRefPubMed Spach MS, Dolber PC (1986) Relating extracellular potentials and their derivatives to anisotropic propagation at a microscopic level in human cardiac muscle. Evidence for electrical uncoupling of side-to-side fiber connections with increasing age. Circ Res 58:356–371CrossRefPubMed
23.
Zurück zum Zitat Jacquemet V, Henriquez CS (2009) Genesis of complex fractionated atrial electrograms in zones of slow conduction: a computer model of microfibrosis. Heart Rhythm 6:803–810CrossRefPubMedPubMedCentral Jacquemet V, Henriquez CS (2009) Genesis of complex fractionated atrial electrograms in zones of slow conduction: a computer model of microfibrosis. Heart Rhythm 6:803–810CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Liu X, Shi HF, Tan HW, Wang XH, Zhou L, Gu JN (2009) Decreased connexin 43 and increased fibrosis in atrial regions susceptible to complex fractionated atrial electrograms. Cardiology 114:22–29CrossRefPubMed Liu X, Shi HF, Tan HW, Wang XH, Zhou L, Gu JN (2009) Decreased connexin 43 and increased fibrosis in atrial regions susceptible to complex fractionated atrial electrograms. Cardiology 114:22–29CrossRefPubMed
25.
Zurück zum Zitat Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo MA, Maseri A (1997) Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation 96:1180–1184CrossRefPubMed Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo MA, Maseri A (1997) Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation 96:1180–1184CrossRefPubMed
26.
Zurück zum Zitat Wi J, Lee HJ, Uhm JS, Kim JY, Pak HN, Lee M, Kim YJ, Joung B (2014) Complex fractionated atrial electrograms related to left atrial wall thickness. J Cardiovasc Electrophysiol 25:1141–1149CrossRefPubMed Wi J, Lee HJ, Uhm JS, Kim JY, Pak HN, Lee M, Kim YJ, Joung B (2014) Complex fractionated atrial electrograms related to left atrial wall thickness. J Cardiovasc Electrophysiol 25:1141–1149CrossRefPubMed
27.
Zurück zum Zitat Eckstein J, Maesen B, Linz D, Zeemering S, van Hunnik A, Verheule S, Allessie M, Schotten U (2011) Time course and mechanisms of endo-epicardial electrical dissociation during atrial fibrillation in the goat. Cardiovasc Res 89:816–824CrossRefPubMed Eckstein J, Maesen B, Linz D, Zeemering S, van Hunnik A, Verheule S, Allessie M, Schotten U (2011) Time course and mechanisms of endo-epicardial electrical dissociation during atrial fibrillation in the goat. Cardiovasc Res 89:816–824CrossRefPubMed
28.
Zurück zum Zitat Hioki M, Matsuo S, Yamane T, Tokutake K, Ito K, Narui R, Tanigawa S, Yamashita S, Tokuda M, Inada K, Date T, Yoshimura M (2012) Adenosine-induced atrial tachycardia and multiple foci initiating atrial fibrillation eliminated by catheter ablation using a non-contact mapping system. Heart Vessels 27:221–226CrossRefPubMed Hioki M, Matsuo S, Yamane T, Tokutake K, Ito K, Narui R, Tanigawa S, Yamashita S, Tokuda M, Inada K, Date T, Yoshimura M (2012) Adenosine-induced atrial tachycardia and multiple foci initiating atrial fibrillation eliminated by catheter ablation using a non-contact mapping system. Heart Vessels 27:221–226CrossRefPubMed
29.
Zurück zum Zitat Lee SH, Tai CT, Hsieh MH, Tsao HM, Lin YJ, Chang SL, Huang JL, Lee KT, Chen YJ, Cheng JJ, Chen SA (2005) Predictors of non-pulmonary vein ectopic beats initiating paroxysmal atrial fibrillation: implication for catheter ablation. J Am Coll Cardiol 46:1054–1059CrossRefPubMed Lee SH, Tai CT, Hsieh MH, Tsao HM, Lin YJ, Chang SL, Huang JL, Lee KT, Chen YJ, Cheng JJ, Chen SA (2005) Predictors of non-pulmonary vein ectopic beats initiating paroxysmal atrial fibrillation: implication for catheter ablation. J Am Coll Cardiol 46:1054–1059CrossRefPubMed
30.
Zurück zum Zitat Matsuo S, Yamane T, Date T, Tokutake K, Hioki M, Narui R, Ito K, Tanigawa S, Yamashita S, Tokuda M, Inada K, Arase S, Yagi H, Sugimoto K, Yoshimura M (2012) Substrate modification by pulmonary vein isolation and left atrial linear ablation in patients with persistent atrial fibrillation: its impact on complex-fractionated atrial electrograms. J Cardiovasc Electrophysiol 23:962–970CrossRefPubMed Matsuo S, Yamane T, Date T, Tokutake K, Hioki M, Narui R, Ito K, Tanigawa S, Yamashita S, Tokuda M, Inada K, Arase S, Yagi H, Sugimoto K, Yoshimura M (2012) Substrate modification by pulmonary vein isolation and left atrial linear ablation in patients with persistent atrial fibrillation: its impact on complex-fractionated atrial electrograms. J Cardiovasc Electrophysiol 23:962–970CrossRefPubMed
31.
Zurück zum Zitat Kumagai K, Toyama H (2013) Usefulness of ablation of complex fractionated atrial electrograms using nifekalant in persistent atrial fibrillation. J Cardiol 61:44–48CrossRefPubMed Kumagai K, Toyama H (2013) Usefulness of ablation of complex fractionated atrial electrograms using nifekalant in persistent atrial fibrillation. J Cardiol 61:44–48CrossRefPubMed
32.
Zurück zum Zitat Shenasa M, Hindricks G, Borggrefe M, Breithandt G, Josephson ME (2012) Cardiac mapping, 4th edn. Wiley-Blackwell, Oxford, pp 1–11 Shenasa M, Hindricks G, Borggrefe M, Breithandt G, Josephson ME (2012) Cardiac mapping, 4th edn. Wiley-Blackwell, Oxford, pp 1–11
33.
Zurück zum Zitat Coronel R, Wilms-Schopman FJ, de Groot JR, Janse MJ, van Capelle FJ, de Bakker JM (2000) Laplacian electrograms and the interpretation of complex ventricular activation patterns during ventricular fibrillation. J Cardiovasc Electrophysiol 11:1119–1128CrossRefPubMed Coronel R, Wilms-Schopman FJ, de Groot JR, Janse MJ, van Capelle FJ, de Bakker JM (2000) Laplacian electrograms and the interpretation of complex ventricular activation patterns during ventricular fibrillation. J Cardiovasc Electrophysiol 11:1119–1128CrossRefPubMed
Metadaten
Titel
Left atrial electrophysiologic feature specific for the genesis of complex fractionated atrial electrogram during atrial fibrillation
verfasst von
Tadashi Hoshiyama
Hiroshige Yamabe
Junjiroh Koyama
Hisanori Kanazawa
Hisao Ogawa
Publikationsdatum
09.04.2015
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 5/2016
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-015-0672-2

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