The Characteristics of Right Atrial Complex Fractionated Atrial Electrograms of Longstanding Atrial Fibrillation between Patients with and without Sinus Rhythm Restoration

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Introduction: This study aimed to clarify whether there is a difference in the anatomic distribution of complex fractionated atrial electrograms (CFAE) in the right atrium (RA) between patients who can get sinus rhythm (SR) or not by extensive biatrial ablation guided by global CFAE map in patients with longstanding persistent (>1 year) atrial fibrillation (AF, LPAF). Methods: Thirty-three patients with LPAF who underwent pulmonary vein isolation (PVI) + Left atrial (LA) and RA CFAE ablation guided by 3-D automated CFAE map (NavX) were included. SR was restored in 16 patients (Group 1) and not in other 17 patients (Group 2). Results: The distribution of maximal density of RA CFAE of Group 1 vs Group 2 was similar at RA appendage (69% vs 71%), at crista terminalis (73% vs 77%), and at the high septum (50% vs 59%), however, significantly lower at sinus venosus in group 1 (25%) compared to that in group 2 (71%, p<0.05) and lower at the superior vena cava in group 1 (25% vs 53% in group 2, NS). Conclusion: Global mapping of RA CFAE guided ablation after PVI>LA CFAE ablation was effective in a half of the patients with LPAF, especially in patients who did not have CFAE at RA-SVC junction such as sinus venosus.