Selective CFAE targeting for atrial fibrillation study (SELECT AF): clinical rationale, design, and implementation

Area of Science:

• Electrophysiology
• Cardiology
• Medical Devices

Background:

• Adjuvant ablation of complex fractionated atrial electrograms (CFAE) with pulmonary vein isolation (PVI) may improve outcomes for persistent atrial fibrillation (AF).
• Extensive CFAE regions can necessitate prolonged ablation, and some may not require intervention.
• Identifying critical CFAE sites for selective ablation is of interest to minimize procedure burden.

Purpose of the Study:

• To compare the efficacy and safety of PVI plus generalized CFAE ablation versus PVI plus selective CFAE ablation in patients with persistent AF.
• To evaluate freedom from atrial arrhythmia at 1 year as the primary efficacy endpoint.
• To assess total radiofrequency (RF) delivery time as the primary safety endpoint.

Main Methods:

• A prospective, multicenter, randomized trial (SELECT AF study) was conducted.
• Patients with symptomatic persistent AF undergoing first-time ablation were randomized 1:1 to either generalized or selective CFAE ablation, in addition to PVI.
• Automated mapping guided both ablation strategies, with a minimum enrollment of 80 subjects.

Main Results:

• The study is designed to evaluate the efficacy and safety of two distinct CFAE ablation strategies.
• Primary endpoints focus on arrhythmia recurrence and procedural radiofrequency time.

Conclusions:

• The SELECT AF study is a randomized trial evaluating selective versus generalized CFAE ablation in addition to PVI for persistent AF.
• The findings will inform optimal ablation strategies for managing persistent atrial fibrillation.