Electrogram-guided substrate ablation with or without pulmonary vein isolation in patients with persistent atrial fibrillation

Heidi Luise Estner, Gabriele Hessling, Gjin Ndrepepa, Jinjin Wu, Tilko Reents, Stefanie Fichtner, Claus Schmitt, Christian V Bary, Christof Kolb, Martin Karch, Bernhard Zrenner, Isabel Deisenhofer
Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology 2008, 10 (11): 1281-7

AIMS: Ablation of complex fractionated atrial electrograms (CFAEs) is a new approach for the treatment of atrial fibrillation (AF). The purpose of the study was to assess the efficacy of CFAE ablation as a stand-alone strategy in patients with persistent AF and to compare it with a combined approach of CFAE ablation and pulmonary vein isolation (PVI).

METHODS AND RESULTS: The study included 77 consecutive patients with persistent AF who underwent radiofrequency (RF) ablation of CFAE as a sole ablation procedure (CFAE group, n = 23 patients) or a combined approach of CFAE ablation and PVI (CFAE plus PVI group, n = 54 patients). Procedures were guided by three-dimensional mapping systems. After the procedure, AF recurrences were evaluated with 7-day Holter recordings at 1, 3, and 6 months and every 6 months thereafter. Treatment failure was defined as >or=1 AF episode lasting >30 s on Holter recordings during follow-up. After a mean follow-up time of 13 +/- 10 months, 2 of 23 patients (9%) with CFAE ablation and 22 of 54 patients (41%) with CFAE plus PVI were in sinus rhythm after a single ablation procedure without anti-arrhythmic medication (P = 0.008).

CONCLUSION: Ablation of CFAE as a stand-alone ablation strategy seems insufficient for the treatment of patients with persistent AF. Pulmonary vein isolation plus CFAE ablation significantly increases the mid-term success rate.

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