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  • Title: Electrogram-guided substrate ablation with or without pulmonary vein isolation in patients with persistent atrial fibrillation.
    Author: Estner HL, Hessling G, Ndrepepa G, Wu J, Reents T, Fichtner S, Schmitt C, Bary CV, Kolb C, Karch M, Zrenner B, Deisenhofer I.
    Journal: Europace; 2008 Nov; 10(11):1281-7. PubMed ID: 18757867.
    Abstract:
    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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