Abstract
Introduction: This study compared pulmonary vein isolation (PVI) plus generalized CFAE ablation vs PVI plus selective CFAE ablation, specifically areas of continuous electrical activity (CEA)(ClinicalTrials.gov NCT00926783 ). Methods: Patients with persistent/high burden AF (age 63±9 yr, LA size 42±6 mm) were enrolled at 6 centers (n=86) & randomized. For the generalized arm, all CFAE regions with an interval confidence level >7 were ablated followed by PVI. For the selective arm, only those CFAE sites with CEA were ablated followed by PVI. For PVI, all PV antra were isolated with confirmed entrance block. Patients were followed with ECG, & 48-hr Holter every 3 mos. AF symptoms were confirmed by loop recording. The primary endpoint was freedom from AF >30 sec at 1 year. Results: Both generalized & selective CFAE ablation prolonged AF cycle length (26±32 ms vs 22±33 ms, p=0.6). AF termination rates were also similar: 37% for generalized & 31% for selective (p=0.6). In both groups, PVI was achieved after CFAE ablation in all patients. RF duration was significantly less in the selective arm vs the generalized arm (25±21 vs. 40±21 min, p=0.008). However, at 1 year follow-up, freedom from AF/AT recurrence was significantly higher in the generalized vs the selective arm after 1 procedure (59% vs 24%, p=0.005). Looking at AF/AT recurrence post 1st or repeat ablation, freedom from recurrence at one year in the generalized arm was 62%, still higher than 33% in the selective arm (p=0.02). There was a trend towards fewer repeat procedures in the generalized vs selective arm (14% vs 33%, p=0.057). Complications included tamponade (n=1) and a sedation-related event (n=1). Conclusions: In persistent/high burden AF, selective CFAE ablation + PVI results in similar AF cycle length prolongation and termination rates with significantly less RF time. However, long-term freedom from AF/AT is significantly better using generalized CFAE ablation + PVI.
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