Mechanism of recurrence after radiofrequency catheter ablation of atrial fibrillation guided by complex fractionated atrial electrograms

Abstract

Recurrence of AF after EGA is usually due to PV tachycardias. Therefore, it may be preferable to systematically map and isolate all PVs during the first procedure. High-dose isoproterenol may be helpful to identify AF drivers.

Evaluation of Linear Lesions in the Left and Right Atrium in Ablation of Long‐standing Atrial Fibrillation

“…By contrast, only 38% of those assigned to the stand‐alone CFAE ablation group were free of AF after two procedures. Similar results were obtained in other studies . However, discrepant data indicate that CFAE ablation might be useless for improving the clinical outcomes of AF ablation.…”

A Randomized Assessment of the Incremental Role of Ablation of Complex Fractionated Atrial Electrograms After Antral Pulmonary Vein Isolation for Long-Lasting Persistent Atrial Fibrillation

“…Ablation of complex fractionated atrial electrograms (CFAEs) without necessarily isolating the PVs has also been reported to eliminate persistent AF (2). However, except in 1 study (2), the clinical efficacy of ablation of CFAEs has been only modest (3), and a recent study suggested that residual PV arrhythmogenicity accounts for a majority of recurrences after ablation of CFAEs (3,4). Therefore, it is possible that ablation of CFAEs would be more helpful if performed in conjunction with antral pulmonary vein isolation (APVI) rather than as a stand-alone ablation strategy.…”

Optimal endpoint for catheter ablation of longstanding persistent atrial fibrillation: A randomized clinical trial

“…It has been postulated that it is not possible to map reentrant circuits underlying the AF substrate, due to their random nature, but these observations demonstrate that AF substrates can be identified by searching areas that have CFAE. Numerous studies have investigated the role of CFAE‐guided ablation in addition to standard PVI in LPeAF and have proven that CFAE‐guided ablation alone may not be sufficient to achieve good long‐term outcomes after AF ablation . CFAE‐guided ablation as a substrate‐modification strategy only serves as an adjuvant, and may not be the only available auxiliary to CPVI for the treatment of persistent AF.…”

“…Numerous studies have investigated the role of CFAEguided ablation in addition to standard PVI in LPeAF and have proven that CFAE-guided ablation alone may not be sufficient to achieve good long-term outcomes after AF ablation. [20][21][22][23][24][25] CFAE-guided ablation as a substrate-modification strategy only serves as an adjuvant, and may not be the only available auxiliary to CPVI for the treatment of persistent AF.…”