CFAE and GP Site Mapping to Guide AF Substrate Ablation

Complex Fractionated Atrial Electrogram (CFAE) is associated with atrial fibrillation (AF) substrate. Culprit CFAE site might be pivot point of rotor wave. However, several sites with CFAE might behave just as bystander sites showing passive fibrillatory conduction. If AF termination is not obtained, is it no use ablating CFAE sites?CFAE ablation would eliminate fibrillatory conduction and help organizing AF, changing AF to atrial tachycardia (AT). CFAE might be related to the focus of driver (AT focus) or the site with activation gradient showing local reentry in small area. Therefore CFAE ablation would restore sinus rhythm in multi factorial ways. Recently important electrophysiological roles of ganglionated plexi (GP) have been emphasized. GP site is defined as showing parasympathetic response to high frequency stimulation. The sites of GP and CFAE are reported to overlap, however, details are unknown. We performed CFAE mapping by measuring fibrillation cycle length and displayed the sites of GP on that map. The result showed wide variety of fibrillation cycle length (30–176 ms) at the GP site. Although GP site may not demonstrate shortest fibrillation cycle length, GP site ablation eliminated AF inducibility in several cases, demonstrating GP is another important marker of AF substrate ablation, apart from CFAE ablation strategy.