Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Clinical Trials / Outcomes D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-137 - Ablation Of Persistent Atrial Fibrillation Based On High Density Voltage Mapping And Complex Fractionated Atrial Electrogram (ID 458)

 J. Hwang: Nothing relevant to disclose.


Background: The pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) catheter ablation. However, PVI alone has been considered insufficient for persistent AF.
Objective: The purpose of this study is to evaluate the efficacy of persistent AF ablation targeting complex fractionated atrial electrogram (CFAE) area within low voltage zone identified by high-resolution mapping in addition to PVI.
Methods: We randomized 50 patients (mean age 58.4 ± 9.5 years old, 86.0% males) with persistent AF to PVI + CFAE groups and PVI only group in a 1:1 ratio. CFAE and voltage mapping were performed simultaneously using a small electrode Pentaray® Catheter with CARTO®3 CONFIDENSE™ module (Biosense Webster®, Inc., Diamond Bar, CA, USA). PVI + CFAE group performed ablation targeting low voltage areas (<0.5mV in AF), which contains CFAE in addition to PVI.
Results: Mean persistent AF duration was 24.0 ± 23.1 months, and the mean left atrial dimension was 4.9 ± 0.5 cm. In the PVI + CFAE group, AF was converted to atrial tachycardia (AT) or sinus rhythm in 15 patients (60%) during the procedure. The PVI + CFAE group showed higher 1-year AF free survival (84.0% PVI + CFAE vs. 44.0 PVI only, p=0.006) without antiarrhythmic drugs. However, no difference in AF/AT free survival (60.0% PVI + CFAE vs. 40.0% PVI only, p= 0.329).

Conclusion: Persistent AF ablation targeting the CFAE area within low voltage zone using high-density voltage mapping showed higher AF free survival as compared to PVI only. However, AT recurrence canceled out the benefit of additional ablation.