Impact of pre-existent areas of complex fractionated atrial electrograms on outcome after pulmonary vein isolation.
BACKGROUND
Atrial fibrillation (AF) drivers outside pulmonary veins (PV) may account for failure after PV isolation. The aim of this study was to characterize pre-existent areas of complex fractionated atrial electrograms (CFAEs) recorded in right atrium (RA) and in coronary sinus (CS) during catheter-based PV isolation and to assess their relation to outcome.


RESULTS
With a tricuspid annulus and CS mapping, CFAEs were retrospectively identified in consecutive patients who underwent PV isolation. Of 224 patients, 161 were found to have CFAEs (81%). No clinical variable was found to be predictive of CFAEs presence. By Kaplan-Meier analysis, following a median follow-up of 23.7 months after a single ablation procedure, 62.8% of patients in the CFAEs+ group and 85.4% of those in the CFAEs- group were free from recurrent atrial tachyarrhythmias (p=0.013). Multivariable Cox regression analysis showed that CFAEs evidence was an independent predictor of recurrence (p=0.007).


CONCLUSIONS
Pre-existent CFAEs, that can be easily identified in RA and CS during PV isolation, are a powerful independent predictor for AF recurrence. This finding may be helpful for refining AF ablation strategies.
Forleo
Giovanni B
GB
Department of Internal Medicine, Division of Cardiology, Policlinico Universitario Tor Vergata, Viale Oxford, 81, 00133 Roma, Italy. forleo@tiscali.it
Mantica
Massimo
M
De Luca
Lucia
L
Dello Russo
Antonio
A
Casella
Michela
M
Santini
Luca
L
Pelargonio
Gemma
G
Romeo
Francesco
F
Tondo
Claudio
C
D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation; D054326:Coronary Sinus / Q000503:physiopathology / Q000601:surgery; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome