[Early Results of Complex Fractionated Atrial Electrogram Mapping Guided Atrial Fibrillation Surgery]

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• The Cox-maze operation is standard for atrial fibrillation (AF) but has limited success based on patient factors.
• Complex fractionated atrial electrograms (CFAE) are crucial electrical substrates in AF.
• A strategy targeting these substrates is needed for improved surgical outcomes.

Purpose of the Study:

• To evaluate the early results of atrial fibrillation surgery guided by preoperative CFAE mapping using a 3D mapping system.
• To assess the feasibility and efficacy of CFAE-guided surgical ablation for AF.

Main Methods:

• Eight patients underwent CFAE mapping-guided AF surgery between January 2015 and August 2016.
• CFAE sites were identified using 3D mapping and ablated via catheter, followed by modified Cox-maze with cryoablation.
• Concomitant cardiac surgeries included mitral valve plasty or replacement, and aortic valve replacement.

Main Results:

• An average of 2.5 CFAE sites in the right atrium and 2.4 in the left atrium were identified.
• Mean CFAE mapping time was 87.6 minutes; mean surgery time was 25.7 minutes.
• At discharge, 7/8 patients were in sinus rhythm, with the remaining patient recovering sinus rhythm by 3 months post-surgery. All patients maintained sinus rhythm at a mean follow-up of 11.7 months.

Conclusions:

• CFAE mapping-guided atrial fibrillation surgery is feasible and effective in the early postoperative period.
• This novel approach may offer an alternative strategy for surgical AF treatment.
• Long-term effects on sinus rhythm maintenance and atrial function require further evaluation.