Mechanism of recurrence after radiofrequency catheter ablation of atrial fibrillation guided by complex fractionated atrial electrograms.
BACKGROUND
A better understanding of the mechanisms of recurrent atrial fibrillation (AF) after radiofrequency ablation of complex, fractionated atrial electrograms (CFAEs) may be helpful for refining AF ablation strategies.


RESULTS
Electrogram-guided ablation (EGA) was repeated in 30 consecutive patients (mean age = 59 +/- 8 years) for recurrent paroxysmal AF, 10 +/- 4 months after the first ablation. During the first procedure, CFAEs were targeted without isolating all pulmonary veins (PVs). During repeat ablation, all PVs and the superior vena cava (SVC) were mapped with a circular catheter and the left atrium was mapped for CFAEs. EGA was performed until AF was rendered noninducible or all identified CFAEs were eliminated. During repeat ablation, > or =1 PV tachycardia was found in 83 PVs in 29 of the 30 patients (97%). Among these 83 PVs, 63 (76%) had not been completely isolated previously. During repeat ablation, drivers originating in a PV or PV antrum were identified only after infusion of isoproterenol (20 mug/min) in 12 patients (40%). At 9 +/- 4 months of follow-up after the repeat ablation procedure, 21 of the 30 patients (70%) were free from recurrent AF and flutter without antiarrhythmic drugs.


CONCLUSIONS
Recurrence of AF after EGA is usually due to PV tachycardias. Therefore, it may be preferable to systematically map and isolate all PVs during the first procedure. High-dose isoproterenol may be helpful to identify AF drivers.
Crawford
Thomas C
TC
Division of Cardiovascular Medicine, University of Michigan, SPC 5853, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5853, USA.
Wimmer
Alan
A
Dey
Sujoya
S
Chalfoun
Nagib
N
Wells
Darryl
D
Sarrazin
Jean-Francois
JF
Kuhne
Michael
M
Frederick
Melissa
M
Jongnarangsin
Krit
K
Good
Eric
E
Chugh
Aman
A
Bogun
Frank
F
Pelosi
Frank
F
Morady
Fred
F
Oral
Hakan
H
D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000517:prevention & control / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome