Selective complex fractionated atrial electrograms targeting for atrial fibrillation study (SELECT AF): a...

Area of Science:

• Electrophysiology
• Cardiology
• Medical Devices

Background:

• Atrial fibrillation (AF) management remains a challenge, particularly persistent or high-burden cases.
• Complex fractionated atrial electrograms (CFAE) are targets for ablation, but strategies vary.
• Pulmonary vein isolation (PVI) is a standard component of AF ablation.

Purpose of the Study:

• To compare the efficacy of generalized CFAE ablation versus selective CFAE ablation targeting continuous electrical activity.
• To evaluate long-term freedom from arrhythmia after different CFAE ablation strategies.
• To assess the need for repeat procedures in patients undergoing CFAE ablation.

Main Methods:

• Eighty-six patients with symptomatic persistent/high-burden paroxysmal AF were randomized into two groups.
• Group I underwent generalized CFAE ablation (interval confidence level >7) followed by PVI.
• Group II underwent selective CFAE ablation (continuous electrical activity sites only) followed by PVI.
• Follow-up included clinical visits, ECGs, and Holter monitoring for one year.

Main Results:

• Both strategies prolonged AF cycle length and had similar acute AF termination rates.
• Radiofrequency duration was significantly less in the selective ablation group (Group II).
• Freedom from AF/atrial flutter/atrial tachycardia recurrence at 1 year was significantly higher in the generalized CFAE ablation group (Group I) (50% vs. 28%, P=0.03).
• Repeat procedures were significantly fewer in Group I (13% vs. 36%, P=0.021).

Conclusions:

• Selective CFAE ablation with PVI reduces radiofrequency time but results in higher long-term recurrence rates.
• Generalized CFAE ablation followed by PVI demonstrates superior long-term efficacy and reduces the need for repeat procedures in AF patients.
• The study highlights the benefit of a comprehensive CFAE ablation approach for persistent AF.