High Dominant Frequencies and Fractionated Potentials Do Not Indicate Focal or Rotational Activation During AF

Lianne N. van Staveren, Richard C. Hendriks, Yannick J.H.J. Taverne, Natasja M.S. de Groot*

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review


Background: Dominant frequencies (DFs) or complex fractionated atrial electrograms (CFAEs), indicative of focal sources or rotational activation, are used to identify target sites for atrial fibrillation (AF) ablation in clinical studies, although the relationship among DF, CFAE, and activation patterns remains unclear. Objectives: This study sought to investigate the relationship between patterns of activation underlying DF and CFAE sites during AF. Methods: Epicardial high-resolution mapping of the right and left atrium including Bachmann's bundle was performed in 71 participants. We identified the highest dominant frequency (DF max) and highest degree of CFAE (CFAE max) with the use of existing clinical criteria and classified patterns of activation as focal or rotational activation and smooth propagation, conduction block (CB), collision and remnant activity, and fibrillation potentials as single, double, or fractionated potentials containing, respectively, 1, 2, or 3 or more negative deflections. Relationships among activation patterns, DF max, and potential types were investigated. Results: DF max were primarily located at the left atrioventricular groove and did not harbor focal activation (proportion focal waves: 0% [IQR: 0%-2%]). Compared with non-DF max sites, DF max were characterized by more frequent smooth propagation (22% [IQR: 7%-48%] vs 17% [IQR: 11%-24%]; P = 0.001), less frequent conduction block (69% [IQR: 51%-81%] vs 74% [IQR: 69%-78%]; P = 0.006), a higher proportion of single potentials (72% [IQR: 55%-84%] vs 6%1 [IQR: 55%-65%]; P = 0.003), and a lower proportion of fractionated potentials (4% [IQR: 1%-11%] vs 12% [IQR: 9%-15%]; P = 0.004). CFAE max were mainly found at the pulmonary veins area, and only 1% [IQR: 0%-2%] of all CFAE max contained focal activation. Compared with non-CFAE max sites, CFAE max sites were characterized by less frequent smooth propagation (1% [IQR: 0%-1%] vs 17% [IQR: 12%-24%]; P < 0.001) and more frequent remnant activity (20% [IQR: 12%-29%] vs 8% [IQR: 5%-10%]; P < 0.001), and harbored predominantly fractionated potentials (52% [IQR: 43%-66%] vs 12% [IQR: 9%-14%]; P < 0.001). Conclusions: Focal or rotational patterns of activation were not consistently detected at DF max domains and CFAE max sites. These findings do not support the concept of targeting DF max or CFAE max according to existing criteria for AF ablation.

Original languageEnglish
Pages (from-to)1082-1096
Number of pages15
JournalJACC: Clinical Electrophysiology
Issue number7
Publication statusPublished - 2023

Bibliographical note

Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care
Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.


  • atrial fibrillation
  • epicardial mapping
  • organized sources


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