Comparison between linear and focal ablation of complex fractionated atrial electrograms in patients with non-paroxysmal atrial fibrillation: A prospective randomized trial

Kwang No Lee; Jong Il Choi; Yun Gi Kim; Suk Kyu Oh; Dong Hyeok Kim; Dae In Lee; Seung Young Roh; Jin Hee Ahn; Jaemin Shim; Sang Weon Park; Young Hoon Kim

doi:10.1093/europace/euy313

Comparison between linear and focal ablation of complex fractionated atrial electrograms in patients with non-paroxysmal atrial fibrillation: A prospective randomized trial

Kwang No Lee, Jong Il Choi, Yun Gi Kim, Suk Kyu Oh, Dong Hyeok Kim, Dae In Lee, Seung Young Roh, Jin Hee Ahn, Jaemin Shim, Sang Weon Park, Young Hoon Kim

Research output: Contribution to journal › Article › peer-review

12 Citations (Scopus)

Abstract

Aims Findings regarding efficacy of substrate modification for non-paroxysmal atrial fibrillation (AF) are inconsistent. We prospectively compared clinical outcomes of complex fractionated atrial electrogram (CFAE)-guided focal ablation (CFA) and CFAE-guided linear ablation (CLA) in patients with non-paroxysmal AF. Methods and results We randomized 150 patients with non-paroxysmal AF into CFA and CLA groups in a 1:1 ratio. Complex fractionated atrial electrogram distribution was evaluated using an automated algorithm of a three-dimensional mapping system. After pulmonary vein isolation (PVI), CFAE-guided ablation was performed in the left atrium and then in the right atrium (RA). When compared with conventional CFA, CLA was performed based on conventional lines, with additional lines. Atrial fibrillation was not induced after PVI alone or with cavotricuspid isthmus ablation in 20.7% of patients. To achieve the endpoint, additional CFAE-guided RA ablation was required in 42.7% and 36.0% of patients undergoing CFA and CLA, respectively (P = 0.403). Atrial fibrillation was terminated during CFAE-guided ablation in 72.9% and 75.0% of patients undergoing CFA and CLA, respectively (P = 0.792). Termination of atrial tachycardia (AT) or non-inducibility of AF/AT was achieved in 61.3% and 68.0% of patients undergoing CFA and CLA, respectively (P = 0.393). The CLA group showed decreased 1-year freedom from AF/AT recurrence (60.0%, CFA vs. 47.3%, CLA; log rank P = 0.085), but no significant difference throughout the follow-up (22.2 ± 21.0 months) (67.1%, CFA vs. 68.9%, CLA; log rank P = 0.298). Conclusion Long-term efficacy of CFAE-guided ablation was unaffected by the ablation technique in patients with non-paroxysmal AF.

Original language	English
Pages (from-to)	598-606
Number of pages	9
Journal	Europace
Volume	21
Issue number	4
DOIs	https://doi.org/10.1093/europace/euy313
Publication status	Published - 2019 Apr 1

Bibliographical note

Funding Information:
This work was supported by a Korea University Grant (J-I.C); and a grant of Korea University Anam Hospital, Seoul, Republic of Korea (J-I.C); and in part by grants from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry Education [NRF-2015R1D1A1A02061859 to J-I.C]; and the Ministry Science, ICT, & Future Planning [NRF-2012R1A1A1013260 to J-I.C].

Publisher Copyright:
© 2019 The Author(s).

Keywords

Atrial fibrillation
Atrial substrate
Catheter ablation
Complex fractionated atrial electrogram
Recurrence

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

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10.1093/europace/euy313

Cite this

Lee, K. N., Choi, J. I., Kim, Y. G., Oh, S. K., Kim, D. H., Lee, D. I., Roh, S. Y., Ahn, J. H., Shim, J., Park, S. W., & Kim, Y. H. (2019). Comparison between linear and focal ablation of complex fractionated atrial electrograms in patients with non-paroxysmal atrial fibrillation: A prospective randomized trial. Europace, 21(4), 598-606. https://doi.org/10.1093/europace/euy313

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title = "Comparison between linear and focal ablation of complex fractionated atrial electrograms in patients with non-paroxysmal atrial fibrillation: A prospective randomized trial",

abstract = "Aims Findings regarding efficacy of substrate modification for non-paroxysmal atrial fibrillation (AF) are inconsistent. We prospectively compared clinical outcomes of complex fractionated atrial electrogram (CFAE)-guided focal ablation (CFA) and CFAE-guided linear ablation (CLA) in patients with non-paroxysmal AF. Methods and results We randomized 150 patients with non-paroxysmal AF into CFA and CLA groups in a 1:1 ratio. Complex fractionated atrial electrogram distribution was evaluated using an automated algorithm of a three-dimensional mapping system. After pulmonary vein isolation (PVI), CFAE-guided ablation was performed in the left atrium and then in the right atrium (RA). When compared with conventional CFA, CLA was performed based on conventional lines, with additional lines. Atrial fibrillation was not induced after PVI alone or with cavotricuspid isthmus ablation in 20.7% of patients. To achieve the endpoint, additional CFAE-guided RA ablation was required in 42.7% and 36.0% of patients undergoing CFA and CLA, respectively (P = 0.403). Atrial fibrillation was terminated during CFAE-guided ablation in 72.9% and 75.0% of patients undergoing CFA and CLA, respectively (P = 0.792). Termination of atrial tachycardia (AT) or non-inducibility of AF/AT was achieved in 61.3% and 68.0% of patients undergoing CFA and CLA, respectively (P = 0.393). The CLA group showed decreased 1-year freedom from AF/AT recurrence (60.0%, CFA vs. 47.3%, CLA; log rank P = 0.085), but no significant difference throughout the follow-up (22.2 ± 21.0 months) (67.1%, CFA vs. 68.9%, CLA; log rank P = 0.298). Conclusion Long-term efficacy of CFAE-guided ablation was unaffected by the ablation technique in patients with non-paroxysmal AF.",

keywords = "Atrial fibrillation, Atrial substrate, Catheter ablation, Complex fractionated atrial electrogram, Recurrence",

author = "Lee, {Kwang No} and Choi, {Jong Il} and Kim, {Yun Gi} and Oh, {Suk Kyu} and Kim, {Dong Hyeok} and Lee, {Dae In} and Roh, {Seung Young} and Ahn, {Jin Hee} and Jaemin Shim and Park, {Sang Weon} and Kim, {Young Hoon}",

note = "Funding Information: This work was supported by a Korea University Grant (J-I.C); and a grant of Korea University Anam Hospital, Seoul, Republic of Korea (J-I.C); and in part by grants from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry Education [NRF-2015R1D1A1A02061859 to J-I.C]; and the Ministry Science, ICT, & Future Planning [NRF-2012R1A1A1013260 to J-I.C]. Publisher Copyright: {\textcopyright} 2019 The Author(s).",

year = "2019",

month = apr,

day = "1",

doi = "10.1093/europace/euy313",

language = "English",

volume = "21",

pages = "598--606",

journal = "Europace",

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TY - JOUR

T1 - Comparison between linear and focal ablation of complex fractionated atrial electrograms in patients with non-paroxysmal atrial fibrillation

T2 - A prospective randomized trial

AU - Lee, Kwang No

AU - Choi, Jong Il

AU - Kim, Yun Gi

AU - Oh, Suk Kyu

AU - Kim, Dong Hyeok

AU - Lee, Dae In

AU - Roh, Seung Young

AU - Ahn, Jin Hee

AU - Shim, Jaemin

AU - Park, Sang Weon

AU - Kim, Young Hoon

N1 - Funding Information: This work was supported by a Korea University Grant (J-I.C); and a grant of Korea University Anam Hospital, Seoul, Republic of Korea (J-I.C); and in part by grants from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry Education [NRF-2015R1D1A1A02061859 to J-I.C]; and the Ministry Science, ICT, & Future Planning [NRF-2012R1A1A1013260 to J-I.C]. Publisher Copyright: © 2019 The Author(s).

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Aims Findings regarding efficacy of substrate modification for non-paroxysmal atrial fibrillation (AF) are inconsistent. We prospectively compared clinical outcomes of complex fractionated atrial electrogram (CFAE)-guided focal ablation (CFA) and CFAE-guided linear ablation (CLA) in patients with non-paroxysmal AF. Methods and results We randomized 150 patients with non-paroxysmal AF into CFA and CLA groups in a 1:1 ratio. Complex fractionated atrial electrogram distribution was evaluated using an automated algorithm of a three-dimensional mapping system. After pulmonary vein isolation (PVI), CFAE-guided ablation was performed in the left atrium and then in the right atrium (RA). When compared with conventional CFA, CLA was performed based on conventional lines, with additional lines. Atrial fibrillation was not induced after PVI alone or with cavotricuspid isthmus ablation in 20.7% of patients. To achieve the endpoint, additional CFAE-guided RA ablation was required in 42.7% and 36.0% of patients undergoing CFA and CLA, respectively (P = 0.403). Atrial fibrillation was terminated during CFAE-guided ablation in 72.9% and 75.0% of patients undergoing CFA and CLA, respectively (P = 0.792). Termination of atrial tachycardia (AT) or non-inducibility of AF/AT was achieved in 61.3% and 68.0% of patients undergoing CFA and CLA, respectively (P = 0.393). The CLA group showed decreased 1-year freedom from AF/AT recurrence (60.0%, CFA vs. 47.3%, CLA; log rank P = 0.085), but no significant difference throughout the follow-up (22.2 ± 21.0 months) (67.1%, CFA vs. 68.9%, CLA; log rank P = 0.298). Conclusion Long-term efficacy of CFAE-guided ablation was unaffected by the ablation technique in patients with non-paroxysmal AF.

AB - Aims Findings regarding efficacy of substrate modification for non-paroxysmal atrial fibrillation (AF) are inconsistent. We prospectively compared clinical outcomes of complex fractionated atrial electrogram (CFAE)-guided focal ablation (CFA) and CFAE-guided linear ablation (CLA) in patients with non-paroxysmal AF. Methods and results We randomized 150 patients with non-paroxysmal AF into CFA and CLA groups in a 1:1 ratio. Complex fractionated atrial electrogram distribution was evaluated using an automated algorithm of a three-dimensional mapping system. After pulmonary vein isolation (PVI), CFAE-guided ablation was performed in the left atrium and then in the right atrium (RA). When compared with conventional CFA, CLA was performed based on conventional lines, with additional lines. Atrial fibrillation was not induced after PVI alone or with cavotricuspid isthmus ablation in 20.7% of patients. To achieve the endpoint, additional CFAE-guided RA ablation was required in 42.7% and 36.0% of patients undergoing CFA and CLA, respectively (P = 0.403). Atrial fibrillation was terminated during CFAE-guided ablation in 72.9% and 75.0% of patients undergoing CFA and CLA, respectively (P = 0.792). Termination of atrial tachycardia (AT) or non-inducibility of AF/AT was achieved in 61.3% and 68.0% of patients undergoing CFA and CLA, respectively (P = 0.393). The CLA group showed decreased 1-year freedom from AF/AT recurrence (60.0%, CFA vs. 47.3%, CLA; log rank P = 0.085), but no significant difference throughout the follow-up (22.2 ± 21.0 months) (67.1%, CFA vs. 68.9%, CLA; log rank P = 0.298). Conclusion Long-term efficacy of CFAE-guided ablation was unaffected by the ablation technique in patients with non-paroxysmal AF.

KW - Atrial fibrillation

KW - Atrial substrate

KW - Catheter ablation

KW - Complex fractionated atrial electrogram

KW - Recurrence

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U2 - 10.1093/europace/euy313

DO - 10.1093/europace/euy313

M3 - Article

C2 - 30649276

AN - SCOPUS:85064513491

SN - 1099-5129

VL - 21

SP - 598

EP - 606

JO - Europace

JF - Europace

IS - 4

ER -

Comparison between linear and focal ablation of complex fractionated atrial electrograms in patients with non-paroxysmal atrial fibrillation: A prospective randomized trial

Abstract

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