Effect of flecainide on the extension and localization of complex fractionated electrogram during atrial fibrillation

Abstract

Aims. Complex fractionated electrogram (CFE) ablation in addition to pulmonary vein isolation is an accepted strategy for the treatment of non-paroxysmal atrial fibrillation (AF). We sought to determine the effect of flecainide on the distribution and extension of CFE areas. Methods. Twenty-three non-paroxysmal AF patients were enrolled in this prospective study. A first CFE map was obtained under baseline conditions by sampling 5 s of continuous recording from the distal electrodes of the ablation catheter. Intravenous flecainide (1 mg/kg) was administered over 10 min and followed by 30-min observation time. A second CFE map was obtained with the same modalities. CFE-mean values, CFE areas, and atrial electrogram amplitude were retrieved from the electro-anatomical mapping system (Ensite NavX). Results. After flecainide administration, CFE-mean values increased (111.5 ± 55.3 vs. 132.3 ± 65.0 ms, p < 0.001) with a decrease of CFE area (32.9%) in all patients. Atrial electrogram amplitude decreased significantly (0.30 ± 0.31 vs. 0.25 ± 0.20 mV, p < 0.001). We observed 80.9% preservation of CFE areas. A CFE mean of 78 ms was the best cutoff for predicting stable CFE areas. Conclusions. Flecainide reduces the extension of CFE areas while preserving their spatial localization. A CFE-mean value <80 ms may be crucial to define and locate stable CFE areas.

Key words::

• ablation
• atrial fibrillation
• complex fractionated electrograms
• flecainide

Acknowledgement

We acknowledge the collaboration and technical support of Peter Schuster and Li-Zhi Sun.

Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.

This work was supported by funding from Helse-Vest, Norway. The study has been presented in part at the Annual Meeting of the Heart Rhythm Society, Denver, CO, May 2013.