Electrogram-guided substrate ablation with or without pulmonary vein isolation in patients with persistent atrial...

Area of Science:

• Electrophysiology
• Cardiology
• Interventional Cardiology

Background:

• Atrial fibrillation (AF) is a common arrhythmia requiring effective treatment strategies.
• Complex fractionated atrial electrograms (CFAEs) are targets for ablation in AF management.
• The efficacy of CFAE ablation as a standalone therapy versus a combined approach needs evaluation.

Purpose of the Study:

• To assess the effectiveness of CFAE ablation as a sole strategy for persistent AF.
• To compare CFAE ablation alone versus a combined approach with pulmonary vein isolation (PVI).

Main Methods:

• Seventy-seven patients with persistent AF underwent radiofrequency ablation.
• Patients were divided into CFAE ablation alone (n=23) or CFAE ablation plus PVI (n=54) groups.
• Three-dimensional mapping guided procedures; recurrences assessed by Holter monitoring up to 13 months.

Main Results:

• After a mean follow-up of 13 months, 9% of patients in the CFAE-alone group remained in sinus rhythm.
• In contrast, 41% of patients in the CFAE plus PVI group achieved sinus rhythm without anti-arrhythmic medication.
• The difference in success rates between the groups was statistically significant (P=0.008).

Conclusions:

• CFAE ablation as a standalone strategy appears insufficient for treating persistent AF.
• Combining pulmonary vein isolation with CFAE ablation significantly enhances mid-term success rates.
• This suggests PVI is a crucial component when targeting CFAEs for persistent AF.