title: Selective complex fractionated atrial electrograms targeting for atrial fibrillation study (SELECT AF): a multicenter, randomized trial.
abstract: BACKGROUND
  This study compared generalized complex fractionated atrial electrograms (CFAE) ablation versus a selective CFAE ablation strategy targeting areas of continuous electric activity.
  
  
  RESULTS
  Subjects with symptomatic, persistent/high-burden paroxysmal atrial fibrillation (AF) were enrolled at 6 centers (n=86) and randomized to 1 of 2 arms. For group I, all CFAE regions with an interval confidence level >7 were ablated followed by pulmonary vein isolation (PVI). For group II, only CFAE sites with continuous electric activity were ablated followed by PVI. For PVI, all 4 PV antra were isolated with confirmed entrance block. Subjects were followed for 1 year with a visit, ECG, and 48-hour Holter every 3 months. Symptoms were confirmed by loop recording. The primary end point was freedom from arrhythmia >30 seconds at 1 year. For both group I and II, CFAE ablation prolonged AF cycle length (25±33 versus 23±33 ms; P=0.78) and resulted in similar rates of AF termination (37% versus 28%; P=0.42). Radiofrequency duration during CFAE ablation was significantly less in group II (23±20 versus 38±20 minutes; P=0.002). At 1-year follow-up, freedom from AF/atrial flutter/atrial tachycardia recurrence was significantly higher in group I versus group II after 1 procedure (50% versus 28%; P=0.03). There were also significantly fewer repeat procedures in group I (13% versus 36%; P=0.021).
  
  
  CONCLUSIONS
  Continuous electric activity ablation+PVI result in a similar incidence of acute AF termination with significantly less radiofrequency time. However, incidence of repeat procedures and long-term recurrence of AF/atrial flutter/atrial tachycardia are significantly lower using generalized CFAE ablation+PVI. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00926783.
authors.affiliation: Southlake Regional Health Centre, Newmarket, Ontario, Canada.
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.forename: Jean
authors.initials: J
authors.lastname: Champagne
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
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: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D002170:Canada; D017115:Catheter Ablation / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007087:Illinois; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D013021:South Australia; D013997:Time Factors; D016896:Treatment Outcome
keywords: ablation; atrial fibrillation; fractionated electrograms; randomized trial