CLINICAL RESEARCH: HEART RHYTHM DISORDER
A Randomized Assessment of the Incremental Role of Ablation of Complex Fractionated Atrial Electrograms After Antral Pulmonary Vein Isolation for Long-Lasting Persistent Atrial Fibrillation
Hakan Oral, MD*,
Aman Chugh, MD,
Kentaro Yoshida, MD,
Jean F. Sarrazin, MD,
Michael Kuhne, MD,
Thomas Crawford, MD,
Nagib Chalfoun, MD,
Darryl Wells, MD,
Warangkna Boonyapisit, MD,
Srikar Veerareddy, MD,
Sreedhar Billakanty, MD,
Wai S. Wong, MD,
Eric Good, DO,
Krit Jongnarangsin, MD,
Frank Pelosi, Jr, MD,
Frank Bogun, MD and
Fred Morady, MD
Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
Manuscript received July 24, 2008;
revised manuscript received September 16, 2008,
accepted October 8, 2008.
* Reprint requests and correspondence: Dr. Hakan Oral, Cardiovascular Center, SPC 5853, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109-5853 (Email: oralh{at}umich.edu).
Objectives: This study sought to determine whether ablation of complex fractionated atrial electrograms (CFAEs) after antral pulmonary vein isolation (APVI) further improves the clinical outcome of APVI in patients with long-lasting persistent atrial fibrillation (AF).
Background: Ablation of CFAEs has been reported to eliminate persistent AF. However, residual pulmonary vein arrhythmogenicity is a common mechanism of recurrence.
Methods: In this randomized study, 119 consecutive patients (mean age 60 ± 9 years) with long-lasting persistent AF underwent APVI with an irrigated-tip radiofrequency ablation catheter. Antral pulmonary vein isolation resulted in termination of AF in 19 of 119 patients (Group A, 16%). The remaining 100 patients who still were in AF were randomized to no further ablation and underwent cardioversion (Group B, n = 50) or to ablation of CFAEs in the left atrium or coronary sinus for up to 2 additional hours of procedure duration (Group C, n = 50).
Results: Atrial fibrillation terminated during ablation of CFAEs in 9 of 50 patients (18%) in Group C. At 10 ± 3 months after a single ablation procedure, 18 of 50 (36%) in Group B and 17 of 50 (34%) in Group C were in sinus rhythm without antiarrhythmic drugs (p = 0.84). In Group A, 15 of 19 patients (79%) were in sinus rhythm. A repeat ablation procedure was performed in 34 of 100 randomized patients (for AF in 30 and atrial flutter in 4). At 9 ± 4 months after the final procedure, 34 of 50 (68%) in Group B and 30 of 50 (60%) in Group C were in sinus rhythm without antiarrhythmic drugs (p = 0.40).
Conclusions: Up to 2 h of additional ablation of CFAEs after APVI does not appear to improve clinical outcomes in patients with long-lasting persistent AF.
Key Words: atrial fibrillation • catheter ablation • electrogram
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Abbreviations and Acronyms
| | AF = atrial fibrillation | | APVI = antral pulmonary vein isolation | | CFAE = complex fractionated atrial electrogram | | PV = pulmonary vein |
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