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

Abstract

Background-There is a paucity of data regarding the mechanism of maintaining atrial fibrillation (AF) after pulmonary vein isolation (PVI) in patients with AF. The aim of this study was to examine the impact of circumferential PVI on the left atrial (LA) substrate characteristics. Methods and Results-Seventy-two AF patients (age, 53Ϯ11 years) underwent mapping and catheter ablation using an NavX system. The biatrial characteristics such as the complex fractionated atrial electrograms (CFEs; based on fractionated intervals) and frequency analysis (based on dominant frequencies) were mapped before and after PVI. PVI with electric isolation was performed in all patients.

Impact of Pulmonary Vein Isolation on Fractionated Atrial Potentials and Ganglionated Plexi in Patients With Persistent Atrial Fibrillation

“…20) Thus, given that PV isolation intensively eliminates the FAP areas around the PVs as shown in the present study or previous ones, 8,9) a greater proportion of FAP areas is supposed to be removed by the PV isolation during AF in patients with paroxysmal AF than in those with persistent AF. Accordingly, the patients with persistent AF in whom FAP areas were extensively eliminated after the PV isolation may instead have had an arrhythmogenic substrate close to that characterizing paroxysmal AF.…”

“…7) The CFAE area 8,9) and number of GPs 10) both are known to be reduced after PV isolation in patients with persistent AF, and therefore this ablation strategy is presumed to be more than just a trigger elimination. In the present study, we attempted to determine what patients with persistent AF could gain a benefit from PV isolation alone by means of analyzing the alterations in the CFAE and GPs before and after the PV isolation.…”

Association Between Epicardial Adipose Tissue Volumes on 3-Dimensional Reconstructed CT Images and Recurrence of Atrial Fibrillation After Catheter Ablation

“…In patients in whom AF was not terminated by PVI or in whom sustained AF was inducible after PVI, additional ablation was performed in the LA according to the results of post-PVI complex fractionated atrial electrogram (CFAE) mapping. 18 The endpoint of this ablation step was termination of the AF during the procedure or abolition of all CFAEs in the LA if AF was not terminated. Anti-arrhythmic drugs previously prescribed to the patients were resumed after the procedure but were stopped 6 months later.…”

“…CFAEs or high dominant frequency sites have been suggested to be important regions for the initiation and/or the maintenance of AF. 18 CFAEs or high dominant frequency sites are commonly distributed at the PV antrum, LA appendage, mitral annulus, or LA roof. 18 Of interest, these sites were similar to the location of the EAT surrounding the LA.…”

Current Status and Future of Cardiac Mapping in Atrial Fibrillation

“…Reprinted with permission from Ref. 32 Nademanee et al reported that CFAE map-guided left atrial (LA) ablation terminated sustained AF in 95% of patients, resulting in excellent clinical outcomes (1 year AF-free rate, 91%) and improved mortality rates [33]. However, the electro-physiologic mechanism of CFAE has not been clearly elucidated yet.…”