title: Selective CFAE targeting for atrial fibrillation study (SELECT AF): clinical rationale, design, and implementation.
abstract: BACKGROUND
  Adjuvant ablation of complex fractionated atrial electrograms (CFAE) in addition to pulmonary vein isolation (PVI) likely improves procedural outcome compared to PVI alone, particularly in patients with persistent atrial fibrillation (AF). However, CFAE regions can be extensive, occasionally requiring a large amount of extra ablation. Some CFAE regions may also represent passive wavefront collision and may not require ablation. Thus, there is interest in identifying more selective CFAE sites that are critical to AF perpetuation, minimizing the amount of adjuvant ablation that must be performed.
  
  
  OBJECTIVE
  The SELECT AF study is a prospective, multicenter, randomized trial comparing a strategy of PVI plus generalized CFAE ablation versus a strategy of PVI plus selective CFAE ablation, focusing on regions of continuous electrical activity (CEA). The primary efficacy endpoint is freedom from atrial arrhythmia at 1 year and the primary safety endpoint is total radiofrequency (RF) delivery time per procedure.
  
  
  METHODS
  Patients undergoing a first time ablation procedure for symptomatic persistent AF will be included. Patients with permanent AF or with left atrial size ≥55 mm will be excluded. Patients will all receive PVI at the time of their ablation, but will be randomized 1:1 to receive adjuvant CFAE ablation using the traditional "generalized" approach, or a "selective" approach targeting only CEA regions. Both strategies will be guided by automated mapping algorithms. This study will enroll a minimum of 80 evaluable subjects; 40 in each randomization group.
  
  
  CONCLUSIONS
  SELECT AF is a randomized trial in patients with persistent AF to evaluate the efficacy of selective versus generalized CFAE ablation in addition to traditional PVI.
authors.affiliation: Southlake Regional Health Centre, Newmarket, Ontario, Canada. atul.verma@utoronto.ca
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
authors.forename: Jean
authors.initials: J
authors.lastname: Champagne
authors.forename: Girish M
authors.initials: GM
authors.lastname: Nair
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: David J
authors.initials: DJ
authors.lastname: Wilber
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000706:statistics & numerical data*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D023381:Endpoint Determination; D006801:Humans; D038622:Internationality; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome