Key result
Circumferential pulmonary vein isolation significantly decreased continuous complex fractionated atrial electrograms from 18% to 12% of left atrial sites (P=0.02).
Why the study?
Does circumferential pulmonary vein isolation alter left atrial substrate characteristics in patients with atrial fibrillation?
Observational (n=72)
Does circumferential pulmonary vein isolation alter left atrial substrate characteristics in patients with atrial fibrillation?
Absolute Event Rate: 12% vs 18%
p-value: p=0.02
Complete PVI alters the distribution of complex fractionated atrial electrograms, and their persistent presence near high-frequency sites is important for AF maintenance.
PVI may reduce continuous CFEs in AF; leaves open whether targeting persistent sites near high-frequency areas improves outcomes.
BACKGROUND: There is a paucity of data regarding the mechanism of maintaining atrial fibrillation (AF) after pulmonary vein isolation (PVI) in patients with AF. The aim of this study was to examine the impact of circumferential PVI on the left atrial (LA) substrate characteristics. METHODS AND RESULTS: Seventy-two AF patients (age, 53+/-11 years) underwent mapping and catheter ablation using an NavX system. The biatrial characteristics such as the complex fractionated atrial electrograms (CFEs; based on fractionated intervals) and frequency analysis (based on dominant frequencies) were mapped before and after PVI. PVI with electric isolation was performed in all patients. In the 45 patients who did not respond to PVI, the continuous CFEs (>8 seconds, 18+/-18% and 12+/-17% of the LA sites, before and after PVI, respectively, P=0.02), degree of LA fractionation (mean fractionated interval: 75.6+/-14.3 msec versus 87.3+/-16.7 msec, P=0.001), and mean LA dominant frequencies (6.92+/-0.88 Hz versus 6.58+/-0.91 Hz, P=0.001) decreased after PVI. Complete PVI altered the distribution of the CFEs toward the LA anteroseptum, mitral annulus, and LA appendage regions. A persistent presence of continuous CFEs in the vicinity of the dominant frequencies sites (observed in 53% patients) correlated with a higher procedural AF termination rate for the CFE ablation (63% versus 23%, P<0.05). CONCLUSIONS: Complete PVI eliminated some CFEs in the LA and altered the distribution of the CFEs. The persistent presence of CFEs before and after PVI in the vicinity of the high frequency sites is important for AF maintenance after PVI.
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Lin et al. (2009) conducted an observational in Atrial fibrillation (n=72). Circumferential pulmonary vein isolation (PVI) vs. Pre-PVI baseline was evaluated on Continuous complex fractionated atrial electrograms (CFEs) as a percentage of left atrial sites (p=0.02). Circumferential pulmonary vein isolation significantly decreased continuous complex fractionated atrial electrograms from 18% to 12% of left atrial sites (P=0.02).
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