It is not clear when to perform right atrial (RA) ablation in patients with chronic AF (CAF). The objective of this study was to compare the clinical and spectral characteristics of AF to identify predictors of RA ablation to terminate AF. In 12 patients (age 65 ± 6 years) with CAF, antral pulmonary vein isolation and ablation of complex fractionated atrial electrograms (CFAEs) were performed until AF terminated (within 120 minutes of radiofrequency energy application). In this retrospective analysis, patients were categorized in 3 groups: Group 1) Termination of AF with left atrial (LA) ablation only (n = 3); Group 2) termination of AF with left and right atrial ablation (n = 4); and Group 3) No termination after left and right atrial ablation (n = 5). Clinical characteristics and dominant frequency (DF) were compared at baseline and 1 min before termination of AF. The 3 groups were similar for all clinical variables, except for prior AF ablation which was more frequent in Group 2. (p = 0.02). At baseline, DF in V1 and CS were comparable in the 3 groups (Table). Only DF in the CS before termination was significantly different among the 3 groups (p = 0.04) and may be predictive of the need for RA ablation in these patients with chronic AF. Higher prevalence of repeat ablation procedures in patients who needed right atrial ablation may indicate that, right atrial drivers are under recognized during initial ablation. Therefore, right atrial drivers should be sought after during redo procedures for AF. Baseline V1 CS Termination with LA ablation 5.0 ± 1.0 5.6 ± 0.5 Termination with LA + RA ablation 4.4 ± 1.0 6.0 ± 0.5 No termination 5.3 ± 1.0 4.8 ± 1.2 p 0.4 0.3 Before termination V1 CS Termination with LA ablation 5.1 ± 1.0 4.8 ± 0.4 Termination with LA + RA ablation 4.8 ± 1.6 5.5 ± 0.5 No termination 4.4 ± 0.8 4.3 ± 0.7 p 0.7 0.04
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