The pathophysiologic basis of fractionated and complex electrograms and the impact of recording techniques on their detection and interpretation

Circulation: Arrhythmia and Electrophysiology

Volumn 3, Issue 2, 2010, Pages 204-213

  De Bakker, Jacques M T ^a,b,c   Wittkampf, Fred H M ^b  

^a Heart Failure Research Center   (Netherlands)

^b UNIVERSITY MEDICAL CENTER UTRECHT   (Netherlands)

^c ROYAL NETHERLANDS ACADEMY OF ARTS AND SCIENCES   (Netherlands)

Author keywords

Ablation; Arrhythmia; Collagen; Electrophysiology; Heart diseases

Indexed keywords

ANISOTROPY; ARTIFACT REDUCTION; AUTONOMIC NERVOUS SYSTEM; DEPOLARIZATION; ELECTROGRAPHY; FILTRATION; FRACTIONATION; HEART ELECTROPHYSIOLOGY; HEART FIBRILLATION; HEART MUSCLE CELL; HEART MUSCLE CONDUCTION SYSTEM; HUMAN; PATHOPHYSIOLOGY; PRIORITY JOURNAL; REVIEW; ARTIFACT; HEART ARRHYTHMIA; HEART DISEASE; HEART FUNCTION TEST; PHYSIOLOGY;

ARRHYTHMIAS, CARDIAC; ARTIFACTS; ELECTROPHYSIOLOGIC TECHNIQUES, CARDIAC; HEART CONDUCTION SYSTEM; HEART DISEASES; HUMANS;

EID: 77951909702     PISSN: 19413149     EISSN: 19413084     Source Type: Journal    
DOI: 10.1161/CIRCEP.109.904763     Document Type: Review

References (57)

1. Josephson ME, Wit AL. Fractionated electrical activity and continuous electrical activity: fact or artifact? Circulation. 1984; 70: 529-532.
2. Gallagher JJ, Kasell JH, Cox JL, Smith WM, Ideker RE, Smith WM. Techniques of intraoperative electrophysiologic mapping. Am J Cardiol. 1982; 49: 221-240.
3. Miller JM, Vassallo JA, Hargrove WC, Josephson ME. Intermittent failure of local conduction during ventricular tachycardia. Circulation. 1985; 72: 1286-1292.
4. Kienzle MG, Miller J, Falcone RA, Harken A, Josephson ME. Intraoperative endocardial mapping during sinus rhythm: relationship to site of origin of ventricular tachycardia. Circulation. 1984; 70: 957-965.
5. Gardner PI, Ursell PC, Fenoglio JJ Jr, Wit AL. Electrophysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts. Circulation. 1985; 72: 596-611.
6. de Bakker JMT, Hauer RNW, Simmers TA. Activation mapping: Unipolar versus bipolar recording. In: Zipes DP, Jalife J, editors. Cardiac Electrophysiology: From Cell to Bedside. 2nd edition. Philadelphia: WB Saunders Company; 1995: 1068-1078.
7. Spach MS, Barr RC, Johnson EA, Kootsey JM. Cardiac extracellular potentials: analysis of complex wave forms about the Purkinje networks in dogs. Circ Res. 1973; 33: 465-473.
8. Durrer D, Formijne P, van Dam R, van Lier A, Buller J, Meyler FL. The electrocardiogram in normal and some abnormal conditions; in revived human fetal heart and in acute and chronic coronary occlusion. Am Heart J. 1961; 61: 303-316.
9. Janse MJ. Electrophysiology and electrocardiology of acute myocardial ischemia. Can J Cardiol. 1986; (suppl A) : 46A-52A.
10. Steinhaus BM. Estimating cardiac transmembrane activation and recovery times from unipolar and bipolar extracellular electrograms: a simulation study. Circ Res. 1989; 64: 449-462.
11. Stevenson WG, Soejima K. Recording techniques for clinical electrophysiology. J Cardiovasc Electrophysiol. 2005; 16: 1017-1022.
12. Haïssaguerre M, Dartigues JF, Warin JF, Le Metayer P, Montserrat P, Salamon R. Electrogram patterns predictive of successful catheter ablation of accessory pathways. Value of unipolar recording mode. Circulation. 1991; 84: 188-202.
13. Ito S, Tada H, Naito S, Kutsumi Y, Miyamori I, Nogami A, Oshima S, Taniguchi K. Randomized comparison of bipolar vs unipolar plus bipolar recordings during atrioventricular junction ablation: importance and efficacy of unipolar recording. Circ J. 2007; 71: 874-879.
14. Durrer D, van der Tweel LH. Spread of activation in the left ventricular wall of the dog. Am Heart J. 1953; 46: 683-691.
15. Lin SL, Wang SP, Kong CW, Chang MS. Artifact simulating ventricular and atrial arrhythmia. Jpn Heart J. 1991; 32: 847-851.
16. Gregg RE, Zhou SH, Lindauer JM, Helfenbein ED, Giuliano KK. What is inside the electrocardiograph? J Electrocardiol. 2008; 41: 8-14.
17. Brouwer J, Nagelkerke D, den Heijer P, Ruiter JH, Mulder H, Begemann MJ, Lie KI. Analysis of atrial sensed far-field ventricular signals: a reassessment. Pacing Clin Electrophysiol. 1997; 20: 916-922.
18. Ho SY, Cabrera JA, Tran VH, Farre J, Anderson RH, Sanchez-Quintana D. Architecture of the pulmonary veins: relevance to radiofrequency ablation. Heart. 2001; 86: 265-270.
19. Spach MS, Miller WT III, Miller-Jones E, Warren RB, Barr RC. Extracellular potentials related to intracellular action potentials during impulse conduction in anisotropic canine cardiac muscle. Circ Res. 1979; 45: 188-204.
20. Lazzara R, Yeh BK, Samet P. Functional anatomy of the canine left bundle branch. Am J Cardiol. 1974; 33: 623-632.
21. Berbari EJ, Lazzara R, El-Sherif N, Scherlag BJ. Extracardiac recordings of His-Purkinje activity during conduction disorders and junctional rhythms. Circulation. 1975; 51: 802-810.
22. McGuire MA, de Bakker JM, Vermeulen JT, Opthof T, Becker AE, Janse MJ. Origin and significance of double potentials near the atrioventricular node: correlation of extracellular potentials, intracellular potentials, and histology. Circulation. 1994; 89: 2351-2360.
23. de Bakker JM, Coronel R, McGuire MA Vermeulen JT, Opthof T, Tasseron S, van Hemel NM, Defauw JJAM. Slow potentials in the atrioventricular junctional area of patients operated on for atrioventricular node tachycardias and in isolated porcine hearts. J Am Coll Cardiol. 1994; 23: 709-715.
24. Jackman WM, Beckman KJ, McClelland JH, Wang X, Friday KJ, Roman CA, Moulton KP, Twidale N, Hazlitt HA, Prior MI. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry, by radiofrequency catheter ablation of slow-pathway conduction. N Engl J Med. 1992; 327: 313-318.
25. Chauvin M, Shah DC, Haissaguerre M, Marcellin L, Brechenmacher C. The anatomic basis of connections between the coronary sinus musculature and the left atrium in humans. Circulation. 2000; 101: 647-652.
26. Antz M, Otomo K, Arruda M, Scherlag BJ, Pitha J, Tondo C, Lazzara R, Jackman WM. Electrical conduction between the right atrium and the left atrium via the musculature of the coronary sinus. Circulation. 1998; 98: 1790-1795.
27. Zheng LR, Chen Y, Lian MJ, Wang LH, Zhu JH, Chen JZ, Tiao QM. Atrial double potential associated with electrical connection between the coronary sinus musculature and the left atrium in a patient with Wolff-Parkinson-White syndrome. J Electrocardiol. 2007; 40: 434-436.
28. Danse PW, Garratt CJ, Mast F, Allessie MA. Preferential depression of conduction around a pivot point in rabbit ventricular myocardium by potassium and flecainide. J Cardiovasc Electrophysiol. 2000; 11: 262-273.
29. Fast VG, Kleber AG. Role of wavefront curvature in propagation of cardiac impulse. Cardiovasc Res. 1997; 33: 258-271.
30. Fast VG, Kleber AG. Cardiac tissue geometry as a determinant of unidirectional conduction block: assessment of microscopic excitation spread by optical mapping in patterned cell cultures and in a computer model. Cardiovasc Res. 1995; 29: 697-707.
31. Derksen R, van Rijen HV, Wilders R, Tasseron S, Hauer RN, Rutten WL, de Bakker JM. Tissue discontinuities affect conduction velocity restitution: a mechanism by which structural barriers may promote wave break. Circulation. 2003; 108: 882-888.
32. Gaudesius G, Miragoli M, Thomas SP, Rohr S. Coupling of cardiac electrical activity over extended distances by fibroblasts of cardiac origin. Circ Res. 2003; 93: 421-428.
33. de Bakker JM, van Capelle FJ, Janse MJ, Tasseron S, Vermeulen JT, de Jonge N, Lahpor JR. Slow conduction in the infarcted human heart: 'zigzag' course of activation. Circulation. 1993; 88: 915-926.
34. Lesh MD, Spear JF, Simson MB. A computer model of the electrogram: what causes fractionation? J Electrocardiol. 1988; 21 (Suppl) : S69-S73.
35. Berenfeld O, Zaitsev AV. The muscular network of the sheep right atrium and frequency-dependent breakdown of wave propagation. Anat Rec A Discov Mol Cell Evol Biol. 2004; 280: 1053-1061.
36. Nademanee K, McKenzie J, Kosar E, Schwab M, Sunsaneewitayakul B, Vasavakul T, Khunnawat C, Ngarmukos T. A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol. 2004; 43: 2044-2053.
37. Konings KT, Kirchhof CJ, Smeets JR, Wellens HJ, Penn OC, Allessie MA. High-density mapping of electrically induced atrial fibrillation in humans. Circulation. 1994; 89: 1665-1680.
38. Gerstenfeld EP, Gojraty S, Valles H, Roux J, Lavi N, Michele J. Complex fractionated atrial electrograms are often due to wavefront collision or functional block rather than focal triggers in a canine model of atrial fibrillation [abstract]. Circulation. 2009; 118: S639.
39. Yamabe H, Morisha K, Tanaka Y, Uemura T, Enomoto K, Ogawa H. Analysis of the mechanism responsible for the genesis of the complex fractionated atrial electrogram during atrial fibrillation using 3D noncontact mapping system [abstract]. Circulation. 2008; 118: S640.
40. Nattel S, Maguy A, Le BS, Yeh YH. Arrhythmogenic ion-channel remodeling in the heart: heart failure, myocardial infarction, and atrial fibrillation. Physiol Rev. 2007; 87: 425-456. (Pubitemid 47084677)
41. Tanaka M, Fujiwara H, Onodera T, Wu DJ, Hamashima Y, Kawai C. Quantitative analysis of myocardial fibrosis in normals, hypertensive hearts, and hypertrophic cardiomyopathy. Br Heart J. 1986; 55: 575-581.
42. Kostin S, Klein G, Szalay Z, Hein S, Bauer EP, Schaper J. Structural correlate of atrial fibrillation in human patients. Cardiovasc Res. 2002; 54: 361-379. (Pubitemid 34327915)
43. Bogun F, Krishnan S, Siddiqui M, Good E, Marine JE, Schuger C, Oral H, Chugh A, Pelosi F, Morady F. Electrogram characteristics in postinfarction ventricular tachycardia: effect of infarct age. J Am Coll Cardiol. 2005; 46: 667-674.
44. Spach MS, Miller WT III, Dolber PC, Kootsey JM, Sommer JR, Mosher CE Jr. 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. 1982; 50: 175-191.
45. Jacquemet V, Henriquez CS. Genesis of complex fractionated atrial electrograms in zones of slow conduction: a computer model of microfibrosis. Heart Rhythm. 2009; 6: 803-810.
46. Spach MS, Heidlage JF, Dolber PC, Barr RC. Mechanism of origin of conduction disturbances in aging human atrial bundles: experimental and model study. Heart Rhythm. 2007; 4: 175-185.
47. Zlochiver S, Yamazaki M, Kalifa J, Berenfeld O. Rotor meandering contributes to irregularity in electrograms during atrial fibrillation. Heart Rhythm. 2008; 5: 846-854.
48. Kalifa J, Tanaka K, Zaitsev, Warren M, Vaidyanathan R, Auerbach D, Pandit S, Vikstrom KL, Ploutz-Snyder R, Talkachou A, Atienza F, Guiraudon G, Jalife J, Berenfeld O. Mechanisms of wave fractionation at boundaries of high-frequency excitation in the posterior left atrium of the isolated sheep heart during atrial fibrillation. Circulation. 2006; 113: 626-633.
49. Lin J, Scherlag BJ, Zhou J, Lu Z, Patterson E, Jackman WM, Lazzara R, Po SS. Autonomic mechanism to explain complex fractionated atrial electrograms (CFAE). J Cardiovasc Electrophysiol. 2007; 18: 1197-1205.
50. Lu Z, Scherlag BJ, Lin J, Niu G, Ghias M, Jackman WM, Lazzara R, Jiang H, Po SS. Autonomic mechanism for complex fractionated atrial electrograms: evidence by fast Fourier transform analysis. J Cardiovasc Electrophysiol. 2008; 19: 835-842.
51. Anderson KP, Walker R, Ershler PR, Fuller M, Dustman T, Menlove R, Karwandee SV, Lux RL. Determination of local myocardial electrical activation for activation sequence mapping: a statistical approach. Circ Res. 1991; 69: 898-917.
52. Anderson KP, Walker R, Fuller M, Dustman T, Ershler PR, Lux RL. Criteria for local myocardial electrical activation: effects of electrogram characteristics. IEEE Trans Biomed Eng. 1993; 40: 169-181.
53. Cabo C, Wharton JM, Wolf PD, Ideker RE, Smith WM. Activation in unipolar cardiac electrograms: a frequency analysis. IEEE Trans Biomed Eng. 1990; 37: 500-508.
54. Damiano RJ Jr, Blanchard SM, Asano T, Cox JL, Lowe JE. Effects of distant potentials on unipolar electrograms in an animal model utilizing the right ventricular isolation procedure. J Am Coll Cardiol. 1988; 11: 1100-1109.
55. Ellis WS, Eisenberg SJ, Auslander DM, Dae MW, Zakhor A, Lesh MD. Deconvolution: a novel signal processing approach for determining activation time from fractionated electrograms and detecting infarcted tissue. Circulation. 1996; 94: 2633-2640.
56. Weiner I, Mindich B, Pitchon R. Determinants of ventricular tachycardia in patients with ventricular aneurysms: results of intraoperative epicardial and endocardial mapping. Circulation. 1982: 65; 856-861.
57. Haqqani HM, Kalman JM, Roberts-Thomson KC, Balasubramaniam RN, Rosso R, Snowdon RL, Sparks PB, Vohra JK, Morton JB. Fundamental differences in electrophysiologic and electroanatomic substrate between ischemic cardiomyopathy patients with and without clinical ventricular tachycardia. J Am Coll Cardiol. 2009; 54: 166-173.