Abstract 2623: Complex Fractionated Atrial Electrogramm or Linear Ablation in Patients With Persistent Atrial Fibrillation? Results From a Prospective Randomized Study
Background: Catheter ablation of areas with complex fractionated atrial electrograms (CFAE) in the left or right atrium is a promising new treatment for atrial fibrillation (AF). We hypothesized that Ablation of CFAEs is not inferior to a linear ablation design.
Methods: A total of 116 patients with persistent AF were randomly assigned to undergo either CFAE Ablation plus segmental Pulmonary vein isolation (PVI) (“spot group”) or circumferential PVI plus additional lines (“linear group”). In both groups, an irrigated-tip ablation catheter (25 to 35 W) and a circular 14-pole mapping catheter for verification of conduction block in the PV was used.
Results: Neither procedure duration, RF application duration or fluoroscopy duration was shorter in one of the ablation strategies. After six months follow up success rate with freedom of arrhythmias in 7-day Holter without antiarrhythmic medication was comparable with 37 patients (63%) after linear ablation and 38 patients (67%) after spot ablation (P=0.2). This was achieved in the linear group in 30 of 59 patients (51%) with a single ablation procedure and 34 of 57 patients (58%) in the spot group, respectively (p=0.9). None of these patients were on antiarrhythmic medication. Persistent AF was more common after the linear ablation approach (p=0.09) but relapses in form of ATs were observed more prevalenty after spot ablation than after linear ablation (P=0.14).
Conclusion: Spot ablation is not inferior to a linear ablation approach in patients with persistent AF. In the linear group relapses were more often persistent AF suggesting that the substrate modification is more effective after CFAE ablation. Contradictory, success after spot ablation was limited by atrial tachycardia during follow up, indicating remaining zones of slow conduction not sufficiently treated by CFAE ablation alone.