J Interv Card Electrophysiol (2014) 39:121–129 DOI 10.1007/s10840-013-9848-9
Substrate modification by adding ablation of localized complex fractionated electrograms after stepwise linear ablation in persistent atrial fibrillation Shiro Nakahara & Tohru Kamijima & Yuichi Hori & Naofumi Tsukada & Akiko Okano & Kan Takayanagi
Received: 11 July 2013 / Accepted: 28 August 2013 / Published online: 30 November 2013 # Springer Science+Business Media New York 2013
Abstract Purpose Linear left atrial (LA) ablation in patients with persistent atrial fibrillation (PsAF) resulting in the elimination of most complex fractionated electrogram (CFE) sites has been demonstrated. This study was designed to evaluate the impact of a localized CFE ablation in addition to a representative linear LA ablation in patients with PsAF. Methods A total of 40 consecutive patients with PsAF underwent construction of CFE and dominant frequency (DF) maps using NavX. A stepwise linear ablation including at the PV antra, septum, roof, mitral annulus, and ridge of the appendage was performed followed by additional ablation of localized CFEs detected by an automatic algorithm. Results A significant reduction in the continuous CFE burden (8 Hz) and linear ablation lines in each anatomic LA region (blue), and percentage of anatomic regions positive for continuous CFEs (40−50 ms) pre- (red) and post(green) linear ablation among the 35 patients in this study. The continuous CFE burden became significantly reduced after the linear ablation (P 1 cm outside of the linear ablation line were identified in the posterior (18/112, 16 %), inferior (37/112, 33 %), and anterior regions (31/112, 28 %). 3.4 Qualitative and quantitative CFE analysis A qualitative and quantitative analysis of the CFEs was performed in 35 patients still in AF just after the step 1 ablation. For the LA regions remote from the distal PVs, there was a dramatic reduction in the percentage of CFE-positive regions after the linear ablation for both regions with a frequency of
Substrate modification by adding ablation of localized complex fractionated electrograms after stepwise linear ablation in persistent atrial fibrillation Shiro Nakahara & Tohru Kamijima & Yuichi Hori & Naofumi Tsukada & Akiko Okano & Kan Takayanagi
Received: 11 July 2013 / Accepted: 28 August 2013 / Published online: 30 November 2013 # Springer Science+Business Media New York 2013
Abstract Purpose Linear left atrial (LA) ablation in patients with persistent atrial fibrillation (PsAF) resulting in the elimination of most complex fractionated electrogram (CFE) sites has been demonstrated. This study was designed to evaluate the impact of a localized CFE ablation in addition to a representative linear LA ablation in patients with PsAF. Methods A total of 40 consecutive patients with PsAF underwent construction of CFE and dominant frequency (DF) maps using NavX. A stepwise linear ablation including at the PV antra, septum, roof, mitral annulus, and ridge of the appendage was performed followed by additional ablation of localized CFEs detected by an automatic algorithm. Results A significant reduction in the continuous CFE burden (8 Hz) and linear ablation lines in each anatomic LA region (blue), and percentage of anatomic regions positive for continuous CFEs (40−50 ms) pre- (red) and post(green) linear ablation among the 35 patients in this study. The continuous CFE burden became significantly reduced after the linear ablation (P 1 cm outside of the linear ablation line were identified in the posterior (18/112, 16 %), inferior (37/112, 33 %), and anterior regions (31/112, 28 %). 3.4 Qualitative and quantitative CFE analysis A qualitative and quantitative analysis of the CFEs was performed in 35 patients still in AF just after the step 1 ablation. For the LA regions remote from the distal PVs, there was a dramatic reduction in the percentage of CFE-positive regions after the linear ablation for both regions with a frequency of
![[Catheter ablation of persistent atrial fibrillation : pulmonary vein isolation, ablation of fractionated electrograms, stepwise approach or rotor ablation?].](/assets/img/hold.png)
