Key result
Ablation of high-dominant frequency and continuous CFAE sites achieved procedural endpoints in 81% of patients, though rotational activation at these sites was limited to 3-4% of sites.
Why the study?
Does ablation of high-DF and continuous CFAE sites following PVI improve procedural outcomes in patients with atrial fibrillation?
Observational (n=32)
Does ablation of high-DF and continuous CFAE sites following PVI improve procedural outcomes in patients with atrial fibrillation?
Rotational activation can be identified at high-DF and continuous CFAE sites during AF, but its ablation following PVI demonstrates limited procedural effects.
Rotational activation mapping may guide AF ablation; hypothesis-generating and should not yet alter practice.
Background High‐dominant frequency (DF) and continuous complex fractionated atrial electrogram (CFAE) sites as surrogates for localized sources maintaining atrial fibrillation (AF) are potential AF ablation targets. This study aimed to evaluate the characteristics of a rotational activation at high‐DF and continuous CFAE sites in AF patients. Methods Thirty‐two consecutive AF patients (5 paroxysmal and 27 non‐paroxysmal) underwent ablation using the NavX system. When AF continued after circumferential pulmonary vein isolation (PVI), high‐DF sites of ≥8 Hz and continuous CFAE sites (fractionated intervals ≤50 ms) in the left (LA) and right (RA) atria were recorded using a high‐density 20‐pole circular mapping catheter for 5 s and ablated. Results The atrial electrogram characteristics during AF were assessed. A total of 2383 AF beats from 89 high‐DF and 19 continuous CFAE sites were investigated. A rotational activation of high‐DF and continuous CFAE sites was also observed at 4% and 3% of LA, and 4% and 4% of RA sites, respectively. However, rotational activation was identified in 29 (91%) of 32 patients (mean 3.0±2.6 beats per patient, 80% in the LA). Procedural endpoints were achieved in 26 (81%) of 32 patients: AF termination ( n =2) and AF cycle length slowing of >10% ( n =26). Conclusions Rotational activation could be identified in high‐DF and continuous CFAE sites during AF, but the documentation was limited. Therefore, only limited effects of rotational activation ablation at high‐DF and/or continuous CFAE sites following PVI could be concluded.
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Kumagai et al. (2016) conducted an observational in Atrial fibrillation (n=32). Ablation at high-dominant frequency (DF) and continuous complex fractionated atrial electrogram (CFAE) sites was evaluated on Procedural endpoints (AF termination and AF cycle length slowing of >10%). Ablation of high-dominant frequency and continuous CFAE sites achieved procedural endpoints in 81% of patients, though rotational activation at these sites was limited to 3-4% of sites.
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