| 최종일¹, 박희남², 박재석¹, 곽재진¹, 노승영¹, 신승용¹, 장진근³, 임홍의¹, 박상원¹, 김영훈¹ |
Background: Areas of complex fractionated electrograms (CFAEs) have been reported to represent critical substrate of the atrial fibrillation (AF), which could be effective target of catheter ablation for AF. However, the end point of focal or regional ablation at CFAE sites was not established yet, furthermore, incomplete CFAE ablation may have a potential to develop atrial tachyarrhythmias. Therefore, we sought to examine the effect of CFAE(s)-guided continuous linear ablation in the patients with AF.
Methods: Of 148 patients who were performed automated CFAE mapping (NavX, 6 seconds segment) during AF using contact bipolar catheter, 30 patients (10 paroxysmal AF, 16 persistent AF, and 4 permanent; 28 male; mean age 55.2±10.8 years; mean LA size 41.6±5.4 mm; mean LVEF 54.7±5.1%) were included in this study. After circumferential isolation of 4 pulmonary veins (PVs), linear ablations were extended to the clustering areas of CFAEs to make bidirectional block across the lines confirmed by differential pacing maneuver.
Results: In 30 patients, 75 CFAEs were identified [68 in left atrium (LA), 7 in right atrium (RA)]. Linear ablations were performed at 61 CFAE areas (mean 2.0±1.5 per patient) including septum (n=23), roof line (n=12), anterior to LA appendage (n=7), perimitral line (n=5), pulmonary vein (n=3), LA wall (n=4), and RA (n=7). During the linear ablation at the CFAE areas, AF or atrial tachycardia (AT) was terminated in 13 patients (43.3%). Five patients were converted to sinus rhythm by electrical cardioversion (CV). After the procedure, none of early recurrence of AF immediately after CV was shown, and sustained AF (> 5 minutes) was inducible in 3 patients (10.0%). During the mean 12.3±9.9 months of follow-up, 90.0% (27/30) were free from AF or AT recurrence with taking antiarrhythmic drugs in 44.4%. No procedure related complication developed.
Conclusion: In addition to PV isolation, linear ablation targeting the CFAE areas identified by automated mapping is feasible and safe in patient with AF, which could be used as one of the effective strategy for substrate modification.
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