Key result
Left atrial posterior wall isolation significantly decreased variable (from 60 to 50 cm2, P<0.001) and continuous (from 4.2 to 3.5 cm2, P=0.036) complex fractionated atrial electrogram areas.
Why the study?
The impact of left atrial posterior wall isolation on complex fractionated atrial electrograms was unknown.
Does left atrial posterior wall isolation affect complex fractionated atrial electrogram areas in patients with persistent atrial fibrillation?
Observational (n=46)
Does left atrial posterior wall isolation affect complex fractionated atrial electrogram areas in patients with persistent atrial fibrillation?
Left atrial posterior wall isolation significantly decreases complex fractionated atrial electrogram areas, and the post-ablation distribution of these areas is associated with AF recurrence.
Caution against assuming clinical benefit from reduced CFAE; leaves open whether LAPWI improves ablation outcomes in persistent AF.
Background The impact of left atrial posterior wall isolation ( LAPWI ) on the complex fractionated atrial electrogram ( CFAE ) is unknown. Methods CFAE mapping was performed before and after LAPWI in 46 patients with persistent atrial fibrillation ( AF ). Results LAPWI decreased both the variable (fractionated index ≤ 120 ms; from 60 ± 4 cm 2 to 50 ± 4 cm 2 , P < 0.001) and continuous (fractionated index ≤ 50 ms; from 4.2 ± 1.0 cm 2 to 3.5 ± 0.9 cm 2 , P = 0.036) CFAE areas. Especially, the CFAE areas on the bottom and roof walls of the left atrium and on the posterior and bottom walls of the right atrium significantly decreased after LAPWI . The distribution of variable CFAE areas was not different between the AF ‐recurrence (n = 9) and AF ‐free (n = 37) groups before LAPWI ; however, it was larger in the anterior and septal walls of the right atrium in the AF ‐recurrence group than in the AF ‐free group after LAPWI (anterior wall, 8% ± 2% vs 5% ± 1%, P = 0.048; septal wall, 23% ± 4% vs 16% ± 1%, P = 0.043). The distribution of continuous CFAE areas on the bottom wall of the right atrium was larger in the AF ‐recurrence group than in the AF ‐free group both before LAPWI (30% ± 20% vs 4% ± 2%, P = 0.008) and after LAPWI (25% ± 25% vs 3% ± 1%, P = 0.027). Conclusions LAPWI decreased the CFAE areas and affected their distribution, which contributed to AF recurrence.
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Nakatani et al. (2019) conducted an observational in persistent atrial fibrillation (n=46). Left atrial posterior wall isolation (LAPWI) vs. Before LAPWI (baseline) was evaluated on Variable and continuous complex fractionated atrial electrogram (CFAE) areas (p=<0.001). Left atrial posterior wall isolation significantly decreased variable (from 60 to 50 cm2, P<0.001) and continuous (from 4.2 to 3.5 cm2, P=0.036) complex fractionated atrial electrogram areas.
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