Catheter ablation targeting complex fractionated atrial electrograms for the control of atrial fibrillation

Abstract

Catheter ablation of persistent atrial fibrillation has a lower success rate than for paroxysmal atrial fibrillation, due to structural, electrical and anatomical remodeling of the left atrium. Ablation strategies targeting complex fractionated atrial electrograms (CFAEs) are commonly employed to identify and eliminate the substrate responsible for atrial fibrillation maintenance in persistent cases. This review discusses the pathophysiology as well as the role of targeting CFAEs in catheter ablation of atrial fibrillation. As our understanding regarding the origin and role of CFAEs in atrial fibrillation continues to evolve, there have been multiple recent studies looking at pathophysiology, distribution and significance of CFAEs in atrial fibrillation. In addition, different ablation strategies targeting CFAEs have been compared with the standard pulmonary vein isolation in persistent as well as paroxysmal atrial fibrillation. Recent meta-analysis studies have striven to identify atrial fibrillation patients who would benefit from CFAE ablation. Whereas CFAE ablation in addition to standard pulmonary vein isolation improves outcomes in patients with persistent atrial fibrillation, there is no benefit of CFAE ablation in paroxysmal atrial fibrillation. Further studies are required to define and identify CFAEs more accurately, in a standardized manner, to enhance the success of catheter ablation and freedom from atrial fibrillation.