Can Analysis of Dominat Frequency Predict the Efficacy of Pulmonary Vein Isolation for Persistent Atrial Fibrillation?

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Introduction: Pulmonary vein isolation (PVI) is not necessarily promising to eliminate persistent atrial fibrillation (AF). The purpose of this study was to elucidate whether dominant frequency (DF) analysis is useful to predict the efficacy of PVI for AF. Methods: DF mapping during AF was performed in 31 AF patients (62.1±10.2 y/o, 21 male, 9 paroxysmal (PAF-group), 11 persistent (CAF-group, median 4, 2–9 months), 11 long-standing persistent (LCAF-group, median 60, 12–132 months)) before PVI. DF was recorded from the PVs, the right atrium, the left atrial appendage, roof, posterior wall, lateral wall, bottom, and septum, and the CS. We categorized the patients, whose highest DF site was obtained in the PV into DFPV-G and in the site other than the PV into DFnonPV-G. Results: During the follow-up period (11.7±2.5 months), in PAF-group, 6/7 (85.7%) patients in DFPV-G and 1/2 (50%) patients in DFnonPV were free of AF (ns). In CAF-group, AF-free ratio in DFPV-G was significantly higher than in DFnonPV-G (5/5 (100%) vs 2/6 (33.3%), p<0.001). In LCAF-group, AF-free ratio in DFPV-G was also significantly higher than in DFnonPV-G (5/6 (83.3%) vs 2/5 (40%), p<0.005). Conclusion: It is suggested that PVI is sufficient to cure persistent AF as well as paroxysmal AF, when the highest DF site is in the PV.