Is There Still a Role for Complex Fractionated Atrial Electrogram Ablation in Addition to Pulmonary Vein Isolation in Patients With Paroxysmal and Persistent Atrial Fibrillation?

Abstract

Background-Ablation of complex fractionated atrial electrograms (CFAEs) has been proposed as a strategy to improve outcomes in atrial fibrillation (AF) catheter ablation, but the use of this technique remains contentious. We aimed to assess the impact of CFAE ablation in addition to pulmonary vein isolation (PVI) in patients undergoing ablation for AF. Methods and Results-We performed a random effects meta-analysis of studies comparing PVI versus PVI+CFAE ablation.The outcomes of freedom from AF/atrial tachycardia after 1 or several ablation procedures and acute procedural-related complications were assessed. Studies were searched on MEDLINE, EMBASE, COCHRANE, and clinicaltrials.gov, and sensitivity analyses were performed. Thirteen studies including a total of 1415 patients were considered eligible.

Catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: a systematic review and meta-analysis

“…This is particularly important as even the optimal strategy to identify these sites and their relevance in procedural outcomes is contentious. 43 Furthermore, the optimal energy source to use is also not clear as all studies in this review have been performed using radiofrequency ablation. A randomised controlled trial to address this matter would be of interest.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Wydaje się, że jest on rzadki również po ablacji za pomocą kriobalonu [734], natomiast może występować nawet u 25% pacjentów po ablacji modyfikującej substrat arytmii w obrębie lewego przedsionka, często z powodu niepełnych linii ablacji. Dlatego u pacjentów z przetrwałym AF ablacja złożonych frakcjonowanych elektrogramów, ablacja rotorów, rutynowe wykonywanie liniowych uszkodzeń lub inne dodatkowe ablacje nie wydają się uzasadnione podczas pierwszego zabiegu [735,738,739]. Dodatkową ablację jako uzupełnienie całkowitej PVI [716] można natomiast rozważyć u pacjentów z nawrotami AF po początkowym zabiegu ablacji [719,740,741].…”

Pharmacological Tests in Atrial Fibrillation Ablation

“…34 These negative results could be explained by the amount of ablation that increases the iatrogenic arrhythmia rate. 87,[97][98][99] To reduce this arrhythmia rate, two recent randomised studies have investigated the effect of ibutilide and amiodarone with respect to PVI and CFAE ablation. Mohanty et al described a 112-patient population treated with amiodarone for persistent AF.…”