Prospective Study of Atrial Fibrillation Termination During Ablation Guided by Automated Detection of Fractionated Electrograms

Abstract

Ablation guided by automated detection of CFAE proved feasible, and was associated with a high AF termination rate in paroxysmal, but not persistent AF. As an adjunct to conventional techniques, it was associated with excellent long-term single procedure outcomes in both groups. Criteria for identifying optimal CFAE sites for ablation, and selection of patients most likely to benefit, require additional study.

Catheter Ablation of Lone Atrial Fibrillation

“…However, circumferential antral PV isolation, particularly if it is combined with additional modification of AF substrate, whether by the linear LA ablation and/or CFAE ablation, may lead to the occurrence of atrial tachycardia in 7.6%-44% of patients [24,42,54,[194][195][196]. After usage of similar ablative strategy (CFAE + PVI), post-procedural incidence of atrial tachycardia was remarkably higher after the ablation of persistent AF than after the ablation of paroxysmal AF (20.0% vs. 2.4%) [197].…”

Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review

“…The highest efficacy reported by Porter and colleagues 33 was associated with one of the first attempts to objectively quantify (CARTO; Biosense Webster) and target CFAE in addition to conventional ablation. The algorithms yielded primary CFAE sites in an average 24% of the atrium, which were accordingly ablated.…”

“…Only two studies in this review objectively reported this statistic 19,33 . Another four other studies 7,13,24,28 have presumably followed all of their patients for at least 12 months given their mean and standard deviation; albeit none of these objectively stated this fact.…”

“…Recently, CFAE ablation has been performed as an adjunct to pulmonary vein isolation 30,31 , PVAI 4,7,32 or PVAI, roof and mitral isthmus ablation 33 . Schmitt et al 30 reported the outcomes of a 5.5 hour procedure beginning with subjectively-assessed CFAE ablation at various regions of the left and right atrium and coronary sinus ostium, followed by conventional pulmonary vein isolation.…”

Contributing Factors Concerning Inconsistencies in Persistent Atrial Fibrillation Ablation Outcomes

“…The ICL, ACI and SCI, as defined by CARTO, were calculated offline with a validated (100% agreement) MATLAB algorithm [4]. CFAE classification was performed by NavX and CARTO using their default clinical thresholds (CFEMean ≤ 120 ms; ICL ≥ 7) [8]. Primary and complementary indices from each system were optimized to reduce the differences in CFAE detection between them using receiver operating characteristic (ROC) curves.…”