897 Automatic 3D Mapping of Complex Fractionated Atrial Electrograms (CFAE) in Patients with Paroxysmal and Persistent Atrial Fibrillation JINJIN WU, M.D., HEIDI ESTNER, M.D., ARMIN LUIK, M.D., EKREM ¨ UCER, M.D., TILKO REENTS, M.D., ANDREAS PFLAUMER, M.D., BERNHARD ZRENNER, M.D., GABRIELE HESSLING, M.D., and ISABEL DEISENHOFER, M.D. From the Deutsches Herzzentrum M ¨ unchen and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universit¨ at M ¨ unchen, Munich, Germany Automatic Electrogram Maps in Atrial Fibrillation. Background: Complex fractionated atrial electrograms (CFAE) are a possible target for atrial fibrillation (AF) ablation and can be visualized in three-dimensional (3D) mapping systems with specialized software. Objective: To use the new CFAE software of CartoXP  (Biosense Webster, Diamond Bar, CA, USA) for analysis of spatial distribution of CFAE in paroxysmal and persistent AF. Methods: We included 16 consecutive patients (6 females; mean 59.3 years) with AF (6 paroxysmal and 10 persistent) undergoing AF ablation. Carto maps of left atrium (LA) were reconstructed. Using the new CFAE software, the degree of local electrogram fractionation was displayed color-coded on the map surface. LA was divided into four regions: anterior wall, inferior wall, septum, and pulmonary veins (PV). The relationship among regions with CFAE visualized and CFAE ablation regions (persistent AF only) was analyzed retrospectively. Results: In paroxysmal and persistent AF, CFAE were observed in all four LA regions. In paroxysmal AF, the density of CFAE around the PV was significantly higher than in other regions (P < 0.05) and higher than in persistent AF (P < 0.05). In persistent AF, CFAE were evenly distributed all over the LA. Of 40 effective ablation sites with significant AF cycle length prolongation, 33 (82.5%) were judged retrospectively by CFAE map as CFAE sites. Conclusion: CFAE software can visualize the spatial distribution of CFAE in AF. CFAE in persistent AF were observed in more regions of LA compared to paroxysmal AF in which CFAE concentrated on the PV. Automatically detected CFAE match well with ablation sites targeted by operators. (J Cardiovasc Electrophysiol, Vol. 19, pp. 897-903, September 2008) cardiac mapping, atrial fibrillation, electrogram analysis, complex fractionated electrograms, three-dimensional reconstruction, catheter ablation techniques Introduction Initiating “triggers” and maintaining mechanisms (“sub- strate”) are considered as the two main electrophysiolog- ical (EP) mechanisms of initiation and perpetuation of atrial fibrillation (AF). 1-3 Triggering foci are electrophysi- ologically well defined as atrial tissue generating repetitive high-frequency ectopies and have been located mainly to the pulmonary veins (PV). 4 The definition of myocardial tissue acting as AF-maintaining substrate is much more difficult, but it has been suggested that areas of complex fractionated electrograms (CFAE) correlate with the AF substrate. Kon- ings et al. analyzed epicardially recorded local unipolar elec- trograms in induced AF and could demonstrate that the local CFAE morphology correlated with areas of slow-conduction Biosense Webster provided software for CFAE analysis. Address for correspondence: Isabel Deisenhofer, M.D., Deutsches Herzzen- trum M ¨ unchen, Lazarettstr. 36, 80636 M¨ unchen, Germany. Fax: 49-89-1218- 4593; E-mail: Deisenhofer@dhm.mhn.de Manuscript received 3 November 2007; Revised manuscript received 30 January 2008; Accepted for publication 8 February 2008. doi: 10.1111/j.1540-8167.2008.01145.x and nonuniform wavelet propagation. 5 Nademanee et al. first reported an approach for AF substrate ablation by mapping and ablating CFAE areas. 6 With this ablation approach becoming increasingly popu- lar, the fast and accurate assessment of local electrogram mor- phology and three-dimensional (3D) visualization of CFAE have come into the focus of interest. In this study, we sought to evaluate the spatial distribution of CFAE in the left atria (LA) of patients with paroxysmal and persistent atrial fibrilla- tion using a new software designed to automatically identify CFAE. This software works in the framework of a 3D map- ping system (CartoXP  ; Biosense Webster, Diamond Bar, CA, USA). Methods Patients’ Characteristics We studied 16 consecutive patients (6 females; mean age 59 ± 12 years) who underwent AF ablation for the first time. Six patients had a history of paroxysmal AF and were in sus- tained AF during intracardiac mapping. Ten patients suffered from persistent AF. The 16 patients had an average AF his- tory of 5.7 ± 5.2 years and were refractory to drug treatment (Table 1).