Complex fractionated atrial electrogram or linear ablation in patients with persistent atrial fibrillation--a...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• Persistent atrial fibrillation (AF) management remains a clinical challenge.
• Catheter ablation targeting complex fractionated atrial electrograms (CFAE) is a potential strategy for persistent AF.
• Comparing CFAE ablation with traditional linear ablation is crucial for optimizing treatment outcomes.

Purpose of the Study:

• To test the hypothesis that CFAE ablation is superior to linear ablation in patients with persistent or long-standing persistent AF.
• To compare the efficacy and recurrence patterns of CFAE ablation versus linear ablation for persistent AF.
• To evaluate freedom from atrial tachyarrhythmia after a single ablation procedure.

Main Methods:

• 116 patients with persistent AF were randomized into two groups: linear ablation (circumferential PVI plus lines) and spot ablation (CFAE ablation plus PVI).
• The primary endpoint was freedom from atrial tachyarrhythmia at 12 months post-ablation, assessed via clinical evaluation and 7-day Holter monitoring, without antiarrhythmic medication.
• Recurrence patterns, including persistent AF and atrial tachycardia (AT), were analyzed for both groups.

Main Results:

• The primary endpoint of freedom from atrial tachyarrhythmia was similar between the linear ablation group (37%) and the spot ablation group (39%) (P = 0.9).
• Overall freedom from atrial tachyarrhythmias, including reablations, was 54% for linear ablation and 56% for spot ablation (P = 0.8).
• Recurrent persistent AF was significantly higher after linear ablation (21/37) compared to spot ablation (11/35) (P = 0.03), while atrial tachycardia was more frequent after spot ablation (10/35 vs 4/37) (P = 0.03).

Conclusions:

• CFAE ablation plus PVI demonstrated comparable efficacy to circumferential PVI plus lines in achieving freedom from symptomatic atrial tachyarrhythmias within one year.
• The study identified distinct recurrence patterns: linear ablation was associated with more persistent AF recurrences, whereas CFAE ablation led to more atrial tachycardias.
• Both ablation strategies are viable for persistent AF, but the choice may influence the type of arrhythmia recurrence observed.