17. Mapping of the Atrial Neural Network: Autonomic Mechanisms Underlying Complex Fractionated Atrial Electrograms and the Substrate for Atrial Fibrillation

  1. Mohammad Shenasa MD6,
  2. Gerhard Hindricks MD7,
  3. Martin Borggrefe MD8,
  4. Günter Breithardt MD9 and
  5. Mark E. Josephson MD10
  1. Youqi Fan1,
  2. Benjamin J. Scherlag2,
  3. Yu Liu3,
  4. Heng Cai4,
  5. Lilei Yu3,
  6. Eric Hepler5,
  7. Shailesh Male2,
  8. Warren M. Jackman2 and
  9. Sunny S. Po2

Published Online: 18 DEC 2012

DOI: 10.1002/9781118481585.ch17

Cardiac Mapping, Fourth Edition

Cardiac Mapping, Fourth Edition

How to Cite

Fan, Y., Scherlag, B. J., Liu, Y., Cai, H., Yu, L., Hepler, E., Male, S., Jackman, W. M. and Po, S. S. (2013) Mapping of the Atrial Neural Network: Autonomic Mechanisms Underlying Complex Fractionated Atrial Electrograms and the Substrate for Atrial Fibrillation, in Cardiac Mapping, Fourth Edition (eds M. Shenasa, G. Hindricks, M. Borggrefe, G. Breithardt and M. E. Josephson), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118481585.ch17

Editor Information

  1. 6

    Attending Physician, Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, San Jose, California, USA

  2. 7

    Professor of Medicine (Cardiology), University Leipzig, Heart Center, Director, Department of Electrophysiology, Leipzig, Germany

  3. 8

    Professor of Medicine (Cardiology), Head, Department of Cardiology, Angiology and Pneumology, University Medical Center, Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

  4. 9

    Professor Emeritus of Medicine and Cardiology, Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany

  5. 10

    Chief, Cardiovascular Medicine Division, Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Herman C. Dana Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA

Author Information

  1. 1

    Sir Run Run Shaw Institution of Clinical Medicine and Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China

  2. 2

    Heart Rhythm Institute at the University of Oklahoma, Health Sciences Center, Oklahoma City, OK, USA

  3. 3

    Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China

  4. 4

    TianJin Medical University General Hospital, TianJin, China

  5. 5

    St. Jude Medical, Atrial Fibrillation Division, Minnetonka, MN, USA

Publication History

  1. Published Online: 18 DEC 2012
  2. Published Print: 10 JAN 2013

ISBN Information

Print ISBN: 9780470670460

Online ISBN: 9781118481585



  • autonomic nervous system;
  • atrial fibrillation;
  • non-contact mapping


Seminal experimental studies showing that prolonged periods of atrial fibrillation (AF) can induce electrophysiological remodeling of the atria so that “AF begets AF,” has become the basis for the understanding of the progression of AF in patients from paroxysmal to persistent to long-standing persistent forms of AF. Clinical studies which initially targeted pulmonary vein firing have refocused on the atrial substrate including the complex fractionated atrial electrograms (CFAEs) invariably found in all forms of AF. More recent experimental and clinical studies have shown that autonomic nerve elements on the heart may play a critical role in the initiation and maintenance of AF and the formation of CFAEs. In this chapter we used iso-potential mapping in the atrium as a starting point and a means of gaining insights into the autonomic factors underlying CFAEs and the substrate for AF.

Subsequently we illustrated previous experimental findings to support the mapping evidence and suggested how these lines of experimental evidence correlate with clinical findings. In conclusion, we emphasize the role of the autonomic innervation of the atria in the pathophysiology of CFAEs and their association with the substrate for AF.