Abstract
Background: Complex fractionated electrogram (CFE) region has been suggested as the substrate of random wave propagation perpetuated after pulmonary vein (PV) isolation in patients with persistent atrial fibrillation (AF). While the rotor has also been suggested as the driving sources. But the relation between CFE and rotor remains unclear. Objectives: We elucidated the significance of CFE and rotor for the maintenance of AF perpetuated after PV isolation in persistent AF patients. Methods: Endocardial non-contact mapping of the left atrium was performed in 16 patients with persistent AF perpetuated after PV isolation. To define the role of CFE and rotor for the maintenance of AF, the number of pivoting activation involved in the CFE was compared with that involved in the rotor activation. The location of rotor and pivoting activation were also compared between the CFE and non-CFE region. Presence of rotor activation was defined when the circular activation around the functional block line once completed its whole reentrant activation. Results: Rotor activation was observed in 11 patients (69%) with a mean number of 2.1±2.0 times/sec. Rotor activation continued at the same site more than once in 2 patients, but shifted to the different location or observed intermittently in the remaining 9 patients. All rotors were observed at CFE region (CFE area; 7.7±2.5 cm2). Total number of pivoting activation was 12.8±4.6 times/sec. The number of pivot activation involved in the CFE region was significantly higher than that in the non-CFE region (12.4±4.9 vs. 0.5±1.0 times/sec, p<0.0001). Thus, 99% of pivoting activations were observed within the CFE region. Pivoting activation involved in the rotor activation was significantly lower than that not involved in the rotor activation (3.5±3.2 vs. 8.7±5.0 times/sec, p<0.01) in the CFE region, but was not different in non-CFE region (0.0±0.0 vs. 0.5±1.0 times/sec, p=NS). Conclusions: Rotor activation was observed within the CFE region after PV isolation. However, few rotors sustained at the stable location. Further, most of pivoting activation was not involved in the rotor activation, suggesting that AF was driven by the meandering non-rotor propagation associated with frequent pivoting activation over the CFE region.
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