Clinical and Electrophysiological Variables Predictive of Favorable Outcome of Additional Ablation of Complex Fractionated Atrial Electrograms in Patients with Persistent Atrial Fibrillation

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Introduction: The benefit of additional ablation of complex fractionated electrograms (CFE) has been reported in treating patients with persistent atrial fibrillation (per-AF). However, the ideal target patients group for this strategy remains unclear. We report a series of cases with per-AF in which addition of CFE ablation to PVI resulted in successful outcome in freedom from AF. Method and Results: Three patients with symptomatic per-AF (2 with lone AF and 1 with tachycardia-induced cardiomyopathy, AF duration 4–16 months, age 56±6 yrs, 3 male, LA diameter of 43, 46 and 49 mm) under went a single ablation with PVI plus CFE ablation using NavX. The amounts of CFE region were variable (12–34 cm2). However, the distribution was similar among patients (in both the LA roof toward the appendage and LA septum anterior to the right superior PV). All CFE regions were located along area with voltage of 0.5–1.0 mV. Although termination of AF was not achieved, the mean cycle length in the LA significantly prolonged by CFE ablation. Following a single procedure, all three patients remained in sinus rhythm at >4-months follow-up. Conclusion: The details of the clinical and electrophysiological characteristics underlying these three cases will be discussed.