title: Electrogram-guided substrate ablation with or without pulmonary vein isolation in patients with persistent atrial fibrillation.
abstract: OBJECTIVE
  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).
  
  
  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 >or=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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Deutsches Herzzentrum München, Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Germany. estner@dhm.mhn.de
authors.forename: Heidi Luise
authors.initials: HL
authors.lastname: Estner
authors.forename: Gabriele
authors.initials: G
authors.lastname: Hessling
authors.forename: Gjin
authors.initials: G
authors.lastname: Ndrepepa
authors.forename: Jinjin
authors.initials: J
authors.lastname: Wu
authors.forename: Tilko
authors.initials: T
authors.lastname: Reents
authors.forename: Stefanie
authors.initials: S
authors.lastname: Fichtner
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.forename: Christian V
authors.initials: CV
authors.lastname: Bary
authors.forename: Christof
authors.initials: C
authors.lastname: Kolb
authors.forename: Martin
authors.initials: M
authors.lastname: Karch
authors.forename: Bernhard
authors.initials: B
authors.lastname: Zrenner
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer