Abstract 13333: Mechanism of Termination of Random Wave Propagation by Ablation of Complex Fractionated Atrial Electrogram Region in Persistent Atrial Fibrillation: Three-dimensional Analysis Using Non-contact Mapping
Background: Catheter ablation of complex fractionated atrial electrogram (CFAE) region has been shown to be effective for the termination of persistent atrial fibrillation (PeAF). However, the mechanism how the spot by spot radiofrequency energy application on the CFAE region terminate the random wave propagation remains unclear.
Objective: The purpose of this study was to define the mechanism of the termination of PeAF by CFAE-targeted ablation.
Methods: Fourteen patients with PeAF(12 male, 62±8 years old) who underwent CFAE ablation after pulmonary vein isolation and linear roof line ablation were included. The left atrial activation sequence was analyzed before and after CFAE ablation using three-dimensional non-contact mapping system (EnSite 3000).
Results: PeAF, perpetuated after pulmonary vein isolation and linear roof line ablation, was maintained by the random wave propagation anchored over the CFAE region. However, the subsequent spot by spot CFAE ablation terminated PeAF in all patients. The mean number of radiofrequency energy application delivered to the CFAE region was 17±10 times.
The average atrial cycle length of the coronary sinus significantly prolonged after CFAE ablation (124.2 ±14.2, vs. 155.4±14.7 msec, P<0.001). The frequency of pivoting activation, wave brake, and wave fusion in CFAE region were significantly decreased by CFAE ablation (8.9±2.7, vs. 5.0±1.8 time/sec; P<0.001, 3.4 ± 1.7 vs. 1.9 ± 0.8 times/sec; p<0.001 and 3.1 ± 1.4 vs. 2.1 ± 1.2 times/sec; P=0.03, respectively). The random wave propagation, associated with the pivoting activation, wave break and wave fusion over the CFAE region which were frequently observed before CFAE ablation decreased after CFAE ablation, then terminated spontaneously (n=2) or organized into regular atrial tachycardia (n=12).
Conclusions: CFAE-targeted ablation delivered in a spot by spot fashion effectively suppressed the pivoting activation, wave break and wave fusion, resulted in the termination of random wave propagation perpetuated after pulmonary vein isolation and linear roof line ablation in PeAF.
- © 2013 by American Heart Association, Inc.