Abstract 12237: The Common Locations of Key Areas to Ablate for Atrial Fibrillation Termination Guided by Complex Fractionated Atrial Electrograms after Pulmonary Vein Isolation: Paroxysmal vs. Persistent Atrial Fibrillation
Introduction: To overcome limited success in curing atrial fibrillation (AF) by pulmonary vein isolation (PVI), complex fractionated atrial electrograms ablation (CFAE-ABL) has been used as an additional procedure after PVI in many AF therapy centers. 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 after PVI remains unclear.
Aims: To investigate the locations of AF-termination-CFAE-areas by CFAE-ABL after PVI and compare these locations between patients with paroxysmal AF (PaAF) and persistent AF (PeAF).
Methods: Our study population included 120 patients with AF (73 with PaAF, 47 with PeAF): 79 patients who underwent combined PVI + CFAE-ABL (50 with PaAF, 29 with PeAF) and 41 patients who underwent CFAE-ABL after previous PVI (23 with PaAF, 18 with PeAF). For 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 PV 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, III) the circumference of the left atrial appendage, IV) the posterior wall aspect of left PVs. For PaAF population, the AF termination rates were higher in the area I) and lower in the area II) than PeAF, but the rankings of AF-termination rates in these four areas were similar between the both population of PaAF and PeAF.
Conclusion: AF-termination-areas by CFAE-ABL after PVI are located commonly in the certain regions, such as anterior area of right PVs, posterior area of left PVs, or surroundings of coronary sinus and left atrial appendage. The distribution of these areas is almost similar between paroxysmal AF and persistent AF.
- © 2012 by American Heart Association, Inc.