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Ablation of persistent atrial fibrillation based on high density voltage mapping and complex fractionated atrial electrograms: A randomized controlled trial

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Affiliated Author(s)
황종민박형섭한성욱이철현김인철조윤경윤혁준정진욱김형섭남창욱허승호김진영김윤석장우성
Alternative Author(s)
Hwang, Jong MinPark, Hyoung SeobHan, Seong WookLee, Cheol HyunKim, In CheolCho, Yun KyeongYoon, Hyuck JunChung, Jin-WookKim, Hyung SeopNam, Chang WookHur, Seung HoKim, Jin YoungKim, Yun SeokJang, Woo Sung
Journal Title
Medicine (Baltimore)
ISSN
1536-5964
Issued Date
2021
Keyword
atrial fibrillationcomplex fractionated atrial electrogramlow voltage areassubstratevoltage mapping
Abstract
Introduction:
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) catheter ablation. However, a PVI alone has been considered insufficient for persistent AF. This study aimed to evaluate the efficacy of persistent AF ablation targeting complex fractionated atrial electrogram (CFAE) areas within low voltage zones identified by high-resolution mapping in addition to the PVI.

Methods:
We randomized 50 patients (mean age 58.4 ± 9.5 years old, 86.0% males) with persistent AF to a PVI + CFAE group and PVI only group in a 1:1 ratio. CFAE and voltage mapping was performed simultaneously using a Pentaray Catheter with the CARTO3 CONFIDENSE module (Biosense Webster, CA, USA). The PVI + CFAE group, in addition to the PVI, underwent ablation targeting low voltage areas (<0.5 mV during AF) containing CFAEs.

Results:
The mean persistent AF duration was 24.0 ± 23.1 months and mean left atrial dimension 4.9 ± 0.5 cm. In the PVI + CFAE group, AF converted to atrial tachycardia (AT) or sinus rhythm in 15 patients (60%) during the procedure. The PVI + CFAE group had a higher 1-year AF free survival (84.0% PVI + CFAE vs 44.0 PVI only, P = .006) without antiarrhythmic drugs. However, there was no difference in the AF/AT free survival (60.0% PVI + CFAE vs 40.0% PVI only, P = .329).

Conclusion:
Persistent AF ablation targeting CFAE areas within low voltage zones using high-density voltage mapping had a higher AF free survival than a PVI only. Although recurrence with AT was frequent in the PVI+CFAE group, the sinus rhythm maintenance rate after redo procedures was 76%.
Department
Dept. of Internal Medicine (내과학)
Dept. of Radiology (영상의학)
Dept. of Thoracic & Cardiovascular Surgery (흉부외과학)
Publisher
School of Medicine (의과대학)
Citation
Hwang, Jongmin et al. (2021). Ablation of persistent atrial fibrillation based on high density voltage mapping and complex fractionated atrial electrograms: A randomized controlled trial. Medicine (Baltimore), 100(31), e26702. doi: 10.1097/MD.0000000000026702
Type
Article
ISSN
1536-5964
DOI
10.1097/MD.0000000000026702
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43973
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
1. School of Medicine (의과대학) > Dept. of Radiology (영상의학)
1. School of Medicine (의과대학) > Dept. of Thoracic & Cardiovascular Surgery (흉부외과학)
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