Efficacy of Additional Ablation of Complex Fractionated Atrial Electrograms for Catheter Ablation of Nonparoxysmal Atrial Fibrillation

Abstract

Ablation of continuous CFEs after PVI and LA linear ablation had a better long-term efficacy based on the results of single-ablation procedure.

Stand-Alone Pulmonary Vein Isolation Versus Pulmonary Vein Isolation With Additional Substrate Modification as Index Ablation Procedures in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation

“…Ablation of CFAEs for the treatment of AF was introduced by Nademanee et al 14 In 3 randomized trials, predominantly with smaller patient cohorts, ablation of CFAEs in addition to PVI demonstrated lower rates of recurrence of atrial tachyarrhythmias than stand-alone PVI. 5,8,10 Furthermore, additional linear ablation demonstrated better clinical outcomes in another 3 randomized trials. 6,7,12 Nonetheless, results of other trials did not show a clinical benefit of additional CFAE ablation, 4,9 and the recently published STAR AF II trial revealed no difference in clinical outcomes when comparing stand-alone PVI to PVI plus additional CFAE or linear ablation in a large cohort of patients with persistent AF.…”

“…3 The optimal strategy for persistent AF is not known, and previous studies investigating more extensive ablation strategies in addition to PVI demonstrated heterogeneous results. [4][5][6][7][8][9][10][11][12] The recently published STAR AF 2 trial (Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial) compared initial stand-alone PVI to PVI with additional ablation of complex fractionated atrial electrograms (CFAEs) or additional linear ablation and could not demonstrate a superior outcome for the additional ablation strategies. 13 The prospective and randomized Alster-Lost-AF © 2017 American Heart Association, Inc.…”

Clinical Outcome of Catheter Ablation in Patients With Nonparoxysmal Atrial Fibrillation

“…The details about the CFAE mapping and ablation were reported in our previous publications. 12,13 In brief, the CFAE ablation was confined to the continuous CFAEs, defined as an electrogram fractionation or repetitive rapid activity lasting for >8 seconds with an averaged fractionated interval of <50 ms over 5 seconds, 14 in the LA and right atrium. The end point of the CFAE ablation was to obtain a prolongation of the cycle length (disappearance of continuous CFAEs), eliminate the CFAEs (thus, a fractionation interval of >120 ms, and disappearance of CFAEs), or abolish the local fractionated potentials (bipolar voltage of <0.05 mV).…”

Spatiotemporal Organization of the Left Atrial Substrate After Circumferential Pulmonary Vein Isolation of Atrial Fibrillation

“…The CFE ablation was confined to the continuous CFEs in the LA and CS. 16,17 Considering the possible complications caused by the long procedure time and efficacy of the RA substrate modification, 18 we did not routinely ablate the CFEs in the RA. The end point of the CFE site ablation was to obtain a prolongation of the cycle length, eliminate the CFEs (thus, FI Ͼ120 ms), or abolish the local fractionated potentials (bipolar voltage Ͻ0.05 mV).…”