Abstract
Haissaguerre et al (Circulation 2014;130:530, PMID 2502839) applied noninvasive signal processing to identify drivers of persistent atrial fibrillation (AF). In 103 consecutive patients with persistent AF, accurate biatrial geometry relative to an array of 252 body surface electrodes was obtained from a computed tomographic scan. The driver domains were catheter ablated by using AF termination as the procedural end point in comparison with the stepwise-ablation control group. In total, 4720 drivers were identified in 103 patients: 3802 (80.5%) reentries and 918 (19.5%) focal breakthroughs. Driver ablation alone terminated 75% and 15% of persistent and long-lasting AF, respectively. The mean radiofrequency delivery to AF termination was 28 ± 17 minutes vs 65 ± 33 minutes in the control group (P < .0001). At 12 months, 85% of patients with AF termination were free from AF, which was similar to the control population (87%; P = NS). The authors conclude that persistent AF in early months after ablation is maintained predominantly by drivers clustered in a few regions, most of them being unstable reentries.
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