Abstract 12225: Atrial Fibrillation Termination Areas during Substrate Ablation Guided by Complex Fractionated Atrial Electrograms are Located Commonly in the Same Anatomic Regions of the Atria with or without Preceding Pulmonary Vein Isolation
Introduction: Ablation of complex fractionated atrial electrograms (CFAE-ABL), as a solitary or an additional strategy plus pulmonary vein isolation (PVI), plays an important role in successful treatment of atrial fibrillation (AF). Several studies have reported that locations of CFAE were identified in certain areas within the atria. However, the distribution of key CFAE-areas to ablate for AF termination remains unclear.
Aims: To investigate the locations of AF-termination-CFAE-areas by CFAE-ABL and compare these locations between the both strategies: CFAE-ABL alone vs. CFAE-ABL after PVI in patients with AF.
Methods: We enrolled 324 patients with AF consisting of 204 patients who underwent CFAE-ABL alone (117 with paroxysmal AF (PaAF), 74 with persistent AF (PeAF), 13 with long-standing PeAF (LS-AF)) and 120 patients who underwent CFAE-ABL after PVI (73 with PaAF (including 23 with prior PVI), 46 with PeAF (including 16 with prior PVI), 1 with LS-AF). For CFAE-ABL alone or a history/s of PVI, spontaneous/induced AF was mapped and CFAE sites were ablated until AF termination/non-inducibility. For combined PVI + CFAE-ABL, all 4 PVs antra were isolated before CFAE-ABL in spontaneous/induced AF. After PVI, CFAE sites were ablated until AF termination/non-inducibility. For the overall, AF-termination-CFAE-sites by CFAE-ABL were recorded using standardized automated mapping software. AF termination rates (the number of AF termination in the area/ the whole number of AF termination) were calculated.
Results: Among all the patients, the most common locations of AF-termination-CFAE-areas were as follows; I) the septal wall aspect of right PVs to the anterior wall, II) the infero-posterior left atrial wall + Coronary Sinus (CS), III) the circumference of the left atrial appendage (LAA), IV) the posterior wall aspect of left PVs. For CFAE-ABL after PVI, the AF termination rates were higher in the area I) and lower in the area IV) than CFAE-ABL alone, but the rankings of AF-termination rates in these four areas were similar between the both strategies.
Conclusion: With or without preceding PVI, AF-termination-areas by CFAE-ABL are located commonly in the certain regions, such as anterior area of right PVs, posterior area of left PVs, or surroundings of CS and LAA.
- © 2012 by American Heart Association, Inc.