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Updated: Jun 6, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Selective CFAE targeting for atrial fibrillation study (SELECT AF): clinical rationale, design, and implementation
Atul Verma1, Prashanthan Sanders, Laurent Macle
1Southlake Regional Health Centre, Newmarket, Ontario, Canada. atul.verma@utoronto.ca
Insights
The SELECT AF study compared generalized versus selective complex fractionated atrial electrogram (CFAE) ablation alongside pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF). Selective CFAE ablation may reduce procedure time while maintaining efficacy.
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.
Background:
Adjuvant ablation of complex fractionated atrial electrograms (CFAE) in addition to pulmonary vein isolation (PVI) likely improves procedural outcome compared to PVI alone, particularly in patients with persistent atrial fibrillation (AF). However, CFAE regions can be extensive, occasionally requiring a large amount of extra ablation. Some CFAE regions may also represent passive wavefront collision and may not require ablation. Thus, there is interest in identifying more selective CFAE sites that are critical to AF perpetuation, minimizing the amount of adjuvant ablation that must be performed.
Objective:
The SELECT AF study is a prospective, multicenter, randomized trial comparing a strategy of PVI plus generalized CFAE ablation versus a strategy of PVI plus selective CFAE ablation, focusing on regions of continuous electrical activity (CEA). The primary efficacy endpoint is freedom from atrial arrhythmia at 1 year and the primary safety endpoint is total radiofrequency (RF) delivery time per procedure.
Methods:
Patients undergoing a first time ablation procedure for symptomatic persistent AF will be included. Patients with permanent AF or with left atrial size ≥55 mm will be excluded. Patients will all receive PVI at the time of their ablation, but will be randomized 1:1 to receive adjuvant CFAE ablation using the traditional "generalized" approach, or a "selective" approach targeting only CEA regions. Both strategies will be guided by automated mapping algorithms. This study will enroll a minimum of 80 evaluable subjects; 40 in each randomization group.
Conclusions:
SELECT AF is a randomized trial in patients with persistent AF to evaluate the efficacy of selective versus generalized CFAE ablation in addition to traditional PVI.
