Radiofrequency Ablation of Complex Fractionated Atrial Electrograms (CFAE): Preferential Sites of Acute Termination and Regularization in Paroxysmal and Persistent Atrial Fibrillation

Authors

  • CLAUS SCHMITT M.D.,

    1. II. Med. Klinik, Schwerpunkt Kardiologie/Angiologie, Klinikum Karlsruhe, Karlsruhe, Germany
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  • HEIDI ESTNER M.D.,

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • BIRGIT HECHER,

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • ARMIN LUIK M.D.,

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • CHRISTOF KOLB M.D.,

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • MARTIN KARCH M.D.,

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • GJIN NDREPEPA M.D.,

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • BERNHARD ZRENNER M.D.,

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • GABRIELE HESSLING M.D.,

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • ISABEL DEISENHOFER M.D.

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • Received 15 April 2007; Revised manuscript received 16 May 2007; Accepted for publication 11 June 2007

Address for correspondence: Isabel Deisenhofer, M.D., Deutsches Herzzentrum München, Lazarettstr. 36, 80636 München, Germany. Fax: +49-89-1218-4593; E-mail: deisenhofer@dhm.mhn.de

Abstract

Introduction: Complex fractionated atrial electrograms (CFAE) have been described as a new target for ablation of atrial fibrillation (AF). This prospective study evaluates the acute effects of CFAE ablation in patients with paroxysmal or persistent AF and analyzes the preferential anatomic sites where these effects occur.

Methods and Results: Ablation of CFAE was performed in 66 symptomatic patients (mean age of 58 ± 12 years) with paroxysmal (n = 36) or persistent AF (n = 30). Termination or regularization of AF during ablation of CFAE was achieved in 56 of 66 patients (84%), with termination in 28 of 66 patients (42%) and regularization of AF in 28 of 66 patients (42%). Ablation of CFAE showed no effect in 10 of 66 patients (16%). Termination of AF occurred at 53 sites and AF regularization at 81 sites. The preferential sites of AF termination or regularization were found around the pulmonary veins (termination n = 15; regularization n = 22), at the anterior wall (termination n = 14; regularization n = 19) and at the interatrial septum (termination n = 8; regularization n = 17).

Conclusion: Termination or regularization of AF was achieved acutely in 84% of patients by ablation of CFAE. The preferential sites of AF termination or regularization were found around the pulmonary veins, at the anterior wall of the LA and at the interatrial septum. These findings may have implications for future ablation concepts.

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