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Does Additional Electrogram-Guided Ablation After Linear Ablation Reduce Recurrence After Catheter Ablation for

Tae-Hoon Kim1, Jae-Sun Uhm1, Jong-Youn Kim1

  • 1Yonsei University Health System, Seoul, Korea.

Journal of the American Heart Association
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Summary

Adding complex fractionated atrial electrogram (CFAE)-guided ablation to standard catheter ablation for long-standing persistent atrial fibrillation (L-PeAF) did not improve clinical outcomes. Further ablation strategies beyond pulmonary vein isolation and linear ablation are not beneficial for L-PeAF patients.

Keywords:
ablationatrial fibrillationcatheter ablationcomplex fractionated atrial electrogram ablationlinear ablationpersistent atrial fibrillation

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Area of Science:

  • Electrophysiology
  • Cardiology
  • Medical Devices

Background:

  • Long-standing persistent atrial fibrillation (L-PeAF) presents treatment challenges.
  • Circumferential pulmonary vein isolation (CPVI) alone may be insufficient for L-PeAF.
  • Optimal adjunctive ablation strategies for L-PeAF remain unclear.

Purpose of the Study:

  • To evaluate the efficacy of additional complex fractionated atrial electrogram (CFAE)-guided ablation in L-PeAF patients.
  • To determine if CFAE-guided ablation improves clinical outcomes after CPVI and linear ablation (Line).

Main Methods:

  • 137 L-PeAF patients underwent radiofrequency catheter ablation.
  • All patients received CPVI and linear ablation (Dallas lesion set).
  • Patients with persistent AF after CPVI+Line were randomized to CPVI+Line or CPVI+Line+CFAE ablation.

Main Results:

  • L-PeAF was successfully defragmented during CPVI+Line in 21.2% of patients.
  • Additional CFAE ablation prolonged procedure time without increasing complications.
  • Clinical recurrence rates at 22.3 months were 17.2% (AF-Defrag), 18.5% (CPVI+Line), and 32.1% (CPVI+Line+CFAE).

Conclusions:

  • CPVI+Line effectively reduces and localizes CFAE areas in L-PeAF.
  • Additional CFAE ablation after CPVI+Line does not improve clinical outcomes in L-PeAF patients.
  • Current ablation strategies beyond CPVI and linear ablation do not enhance L-PeAF treatment success.