Complex Fractionated Atrial Electrograms

Abstract

Since its inception in the 1990s, catheter ablation of atrial fibrillation (AF) has been a continuously evolving procedure. Ablation strategies have adapted to advances in technology including new catheter designs, innovations in mapping systems, and alternative energy sources. Moreover, catheter ablation has stimulated and responded to an improved understanding of the mechanisms of initiation and perpetuation of AF. Over the past 15 years, many centers have spent considerable effort in defining optimal ablation strategies for elimination of paroxysmal and nonparoxysmal AF. Article see p 143 The pulmonary veins were recognized early by Haissaguerre et al1,2 as a frequent source of triggers for AF. Pulmonary vein isolation quickly became the cornerstone of catheter ablation of AF and sparked its rise as a promising tool to eliminate symptomatic and drug-refractory AF.3,4 This was first performed by ostial ablation, but, because of the risk of pulmonary vein stenosis and recognition of vital antral drivers, an antral pulmonary vein isolation (APVI) strategy evolved.3,5 Adjuvants to APVI have been proposed, including ablation of complex fractionated atrial electrograms (CFAE). Initial experience suggested that CFAE ablation is a viable stand-alone strategy,6 but this experience has not been reproducible.7 …