Europace Advance Access published online on August 29, 2008
Europace, doi:10.1093/europace/eun244
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Electrogram-guided substrate ablation with or without pulmonary vein isolation in patients with persistent atrial fibrillation
1 Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Lazarettstrasse 36, D-80636 München, Germany; 2 Städtisches Klinikum Karlsruhe, Germany
Aims: Ablation of complex fractionated atrial electrograms (CFAEs) is a new approach for the treatment of atrial fibrillation (AF). The purpose of the study was to assess the efficacy of CFAE ablation as a stand-alone strategy in patients with persistent AF and to compare it with a combined approach of CFAE ablation and pulmonary vein isolation (PVI).
Methods and results: The study included 77 consecutive patients with persistent AF who underwent radiofrequency (RF) ablation of CFAE as a sole ablation procedure (CFAE group, n = 23 patients) or a combined approach of CFAE ablation and PVI (CFAE plus PVI group, n = 54 patients). Procedures were guided by three-dimensional mapping systems. After the procedure, AF recurrences were evaluated with 7-day Holter recordings at 1, 3, and 6 months and every 6 months thereafter. Treatment failure was defined as 
1 AF episode lasting >30 s on Holter recordings during follow-up. After a mean follow-up time of 13 ± 10 months, 2 of 23 patients (9%) with CFAE ablation and 22 of 54 patients (41%) with CFAE plus PVI were in sinus rhythm after a single ablation procedure without anti-arrhythmic medication (P = 0.008).
Conclusion: Ablation of CFAE as a stand-alone ablation strategy seems insufficient for the treatment of patients with persistent AF. Pulmonary vein isolation plus CFAE ablation significantly increases the mid-term success rate.
Key Words: Persistent atrial fibrillation, Ablation, Pulmonary vein isolation, Complex fractionated atrial electrograms
* Corresponding author. Tel: +49 89 12182020; fax: +49 89 12184593. E-mail address: estner{at}dhm.mhn.de
Manuscript submitted 22 June 2008. Accepted after revision 8 August 2008.
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