Impact of Antiarrhythmic Drugs on Complex Fractionated Atrial Electrograms

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Background: Ablation of complex fractionated atrial electrograms (CFAE) is now performed in patients with persistent atrial fibrillation (AF). However, CFAE are sometimes observed over diffuse areas and extensive ablation is often necessary to eliminate all CFAE or to terminate AF. The purpose of this study was to evaluate the effects of antiarrhythmic drugs (AAD) on CFAE. Methods and Results: Sixty patients, including 38 with longstanding persistent AF and 22 with persistent AF, underwent box isolation using NavX system. After box isolation, CFAE maps were created before and after infusion of a pure Na+ blocker, pilsicainide (1 mg/kg), in 30 patients or a pure IKr blocker, nifekalant (0.3 mg/kg), in 30 patients. Nifekalant had a greater effect on AF termination than pilsicainide (33% versus 7%, P=0.01). Both AADs similarly decreased degree of LA fractionation and reduced CFAE. Ablation of CFAE localized by pilsicainide and nifekalant terminated AF in 20% and 27% of the patients, respectively. After a single ablation procedure, patients in whom AF was terminated by minimal CFAE ablation had a lower recurrence rate than those in whom AF was not terminated despite extensive CFAE ablation (8% versus 29%, P=0.03). Conclusions: Both pilsicainide and nifekalant reduce CFAE, and nifekalant has a greater effect on AF termination than pilsicainide. Ablation of only CFAEs localized with AAD may be sufficient for clinical efficacy.
日本不整脈学会の論文