Interv Akut Kardiol. 2013;12(1):12-18

Relationship between automatically detected complex fractionated electrograms and sites of termination of longstanding persistent atrial fibrillation during catheter ablation

Martin Fiala^1,2, Dan Wichterle^3,4, Veronika Bulková^1,4, Libor Škňouřil¹, Renáta Nevřalová¹, Jan Chovančík¹, Jaroslav Januška¹, Jindřich Špinar²

¹ Department of Cardiology, Heart Centre, Hospital Podlesí a. s., Třinec

² Department of Cardiology and Angiology, University Hospital, Masaryk University, Brno

³ Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague

⁴ Department of Cardiology and Angiology, First Faculty of Medicine, Charles University, Prague

Background: Complex fractionated atrial electrograms (CFAE) may provide a target for ablation of persistent atrial fibrillation (AF).

This study evaluated relationship between the automatically detected CFAE in the atria and the sites of long-standing persistent AF

termination during ablation.

Methods: Fifty consecutive patients underwent a stepwise ablation for long-standing persistent AF. Left atrial (LA), right atrial (RA), and

coronary sinus (CS) electroanatomic maps with automatically detected CFAE were obtained before ablation. Stepwise ablation with the

ideal endpoint of sinus rhythm restoration was subsequently performed using plain electroanatomic maps. The relationship between

CFAE sites and AF termination sites was retrospectively analyzed in 38 patients in whom ablation terminated AF.

Results: There were 70 LA CFAE sites, 48 RA CFAE sites, and 20 CS CFAE sites found in 35 (92 %), 30 (79 %), and 19 (50 %) patients, respectively.

Mean distance between the AF termination site and the closest CFAE site was 21.7±17 mm. Distance between the AF termination

site and the closest CFAE site ≤ 10, or 11–20 mm was found in 11 (29 %), and 10 (26 %) patients, respectively. AF termination was achieved

after ablation of 85 ± 28 % LA CFAE sites, 58±28 % CS CFAE sites, and 16 ± 33 % RA CFAE sites.

Conclusions: Although the CFAE sites and AF termination sites did not directly correlate in a majority of the patients, most of the LA CFAE sites

and more than half of the CS CFAE sites had been targeted before AF termination, suggesting rather cumulative effect of CFAE ablation.

Klíčová slova: atrial fibrillation, long-standing persistent, catheter ablation, complex fractionated atrial electrograms.

Zveřejněno: 21. únor 2013  Zobrazit citaci