26. Recent Observations in Mapping of Complex Fractionated Atrial Electrograms in Atrial Fibrillation

  1. Mohammad Shenasa MD2,
  2. Gerhard Hindricks MD3,
  3. Martin Borggrefe MD4,
  4. Günter Breithardt MD5 and
  5. Mark E. Josephson MD6
  1. Koonlawee Nademanee and
  2. Montawatt Amnueypol

Published Online: 18 DEC 2012

DOI: 10.1002/9781118481585.ch26

Cardiac Mapping, Fourth Edition

Cardiac Mapping, Fourth Edition

How to Cite

Nademanee, K. and Amnueypol, M. (2013) Recent Observations in Mapping of Complex Fractionated Atrial Electrograms in 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.ch26

Editor Information

  1. 2

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

  2. 3

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

  3. 4

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

  4. 5

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

  5. 6

    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. Pacific Rim Electrophysiology Research Institute at White Memorial Hospital, Los Angeles, CA, USA and Bangkok Medical Center, Bangkok, Thailand

Publication History

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

ISBN Information

Print ISBN: 9780470670460

Online ISBN: 9781118481585



  • atrial fibrillation;
  • complex fractionated atrial electrograms;
  • ganglionic plexi;
  • catheter ablation;
  • pulmonary veins;
  • radio-frequency ablation;
  • atrial electrograms;
  • premature atrial contractions


The myriad pathologies leading to and resulting from atrial fibrillation (AF) have led to many theories regarding how substrate should be defined and how to reconcile substrate ablation with trigger ablation. The identification of spatiotemporally stable areas of very low amplitude short cycle length (CL) complex fractionated atrial electrograms (CFAEs) in a sea of otherwise discrete normal amplitude and relatively longer CL electrograms led to ablate the CFAEs as markers of abnormal substrate. This pure substrate-based ablation strategy has resulted in remarkable success with great benefit including stroke and mortality reduction in high-risk patients with very long standing persistent AF. However, these findings have not been consistently replicated by others. In this review, we discuss the prevailing mechanisms underlying CFAEs, how to map and ablate CFAE sites, correlation of CFAE areas to those of ganglionic plexi, clinical outcomes of the approach, and the controversy surrounding targeting CFAEs as substrate sites for AF ablation.