title: A randomized assessment of the incremental role of ablation of complex fractionated atrial electrograms after antral pulmonary vein isolation for long-lasting persistent atrial fibrillation.
abstract: OBJECTIVE
  This study sought to determine whether ablation of complex fractionated atrial electrograms (CFAEs) after antral pulmonary vein isolation (APVI) further improves the clinical outcome of APVI in patients with long-lasting persistent atrial fibrillation (AF).
  
  
  BACKGROUND
  Ablation of CFAEs has been reported to eliminate persistent AF. However, residual pulmonary vein arrhythmogenicity is a common mechanism of recurrence.
  
  
  METHODS
  In this randomized study, 119 consecutive patients (mean age 60 +/- 9 years) with long-lasting persistent AF underwent APVI with an irrigated-tip radiofrequency ablation catheter. Antral pulmonary vein isolation resulted in termination of AF in 19 of 119 patients (Group A, 16%). The remaining 100 patients who still were in AF were randomized to no further ablation and underwent cardioversion (Group B, n = 50) or to ablation of CFAEs in the left atrium or coronary sinus for up to 2 additional hours of procedure duration (Group C, n = 50).
  
  
  RESULTS
  Atrial fibrillation terminated during ablation of CFAEs in 9 of 50 patients (18%) in Group C. At 10 +/- 3 months after a single ablation procedure, 18 of 50 (36%) in Group B and 17 of 50 (34%) in Group C were in sinus rhythm without antiarrhythmic drugs (p = 0.84). In Group A, 15 of 19 patients (79%) were in sinus rhythm. A repeat ablation procedure was performed in 34 of 100 randomized patients (for AF in 30 and atrial flutter in 4). At 9 +/- 4 months after the final procedure, 34 of 50 (68%) in Group B and 30 of 50 (60%) in Group C were in sinus rhythm without antiarrhythmic drugs (p = 0.40).
  
  
  CONCLUSIONS
  Up to 2 h of additional ablation of CFAEs after APVI does not appear to improve clinical outcomes in patients with long-lasting persistent AF.
authors.affiliation: Cardiovascular Center, University of Michigan, Ann Arbor, 48109-5853, USA. oralh@umich.edu
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshida
authors.forename: Jean F
authors.initials: JF
authors.lastname: Sarrazin
authors.forename: Michael
authors.initials: M
authors.lastname: Kuhne
authors.forename: Thomas
authors.initials: T
authors.lastname: Crawford
authors.forename: Nagib
authors.initials: N
authors.lastname: Chalfoun
authors.forename: Darryl
authors.initials: D
authors.lastname: Wells
authors.forename: Warangkna
authors.initials: W
authors.lastname: Boonyapisit
authors.forename: Srikar
authors.initials: S
authors.lastname: Veerareddy
authors.forename: Sreedhar
authors.initials: S
authors.lastname: Billakanty
authors.forename: Wai S
authors.initials: WS
authors.lastname: Wong
authors.forename: Eric
authors.initials: E
authors.lastname: Good
authors.forename: Krit
authors.initials: K
authors.lastname: Jongnarangsin
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
authors.forename: Frank
authors.initials: F
authors.lastname: Bogun
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation; D004594:Electrophysiology; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome