PURPOSE: Linear left atrial (LA) ablation in patients with persistent atrial fibrillation (PsAF) resulting in the elimination of most complex fractionated electrogram (CFE) sites has been demonstrated. This study was designed to evaluate the impact of a localized CFE ablation in addition to a representative linear LA ablation in patients with PsAF. METHODS: A total of 40 consecutive patients with PsAF underwent construction of CFE and dominant frequency (DF) maps using NavX. A stepwise linear ablation including at the PV antra, septum, roof, mitral annulus, and ridge of the appendage was performed followed by additional ablation of localized CFEs detected by an automatic algorithm. RESULTS: A significant reduction in the continuous CFE burden (<50 ms) after the linear ablation (69 vs. 21 %; P < 0.0001) was confirmed, and localized CFEs (40-120 ms) were observed with a significant predilection for the anterior (30 %), posterior (30 %), and inferior LA (38 %) regions (P < 0.01). Comparing the localized CFEs with higher frequency sources, 45 % (70/156) of the localized CFE sites included continuous CFE regions, and 59 % (92/156) of those sites overlapped with the high-DF sites (>8 Hz). Additional localized CFE-targeted ablation further terminated PsAF in 20 % of the patients and further increased the mean CFE cycle length (110 ± 31 to 125 ± 39 ms; P = 0.0033) and decreased the DF (6.0 ± 0.8 to 5.7 ± 0.7 Hz; P = 0.0013) within the CS. CONCLUSIONS: The presence of localized CFE sites with a predilection for particular LA regions after a representative linear LA ablation could provide the optimal sites for selective substrate modification of the atrial fibrillation substrate in patients with PsAF.
PURPOSE: Linear left atrial (LA) ablation in patients with persistent atrial fibrillation (PsAF) resulting in the elimination of most complex fractionated electrogram (CFE) sites has been demonstrated. This study was designed to evaluate the impact of a localized CFE ablation in addition to a representative linear LA ablation in patients with PsAF. METHODS: A total of 40 consecutive patients with PsAF underwent construction of CFE and dominant frequency (DF) maps using NavX. A stepwise linear ablation including at the PV antra, septum, roof, mitral annulus, and ridge of the appendage was performed followed by additional ablation of localized CFEs detected by an automatic algorithm. RESULTS: A significant reduction in the continuous CFE burden (<50 ms) after the linear ablation (69 vs. 21 %; P < 0.0001) was confirmed, and localized CFEs (40-120 ms) were observed with a significant predilection for the anterior (30 %), posterior (30 %), and inferior LA (38 %) regions (P < 0.01). Comparing the localized CFEs with higher frequency sources, 45 % (70/156) of the localized CFE sites included continuous CFE regions, and 59 % (92/156) of those sites overlapped with the high-DF sites (>8 Hz). Additional localized CFE-targeted ablation further terminated PsAF in 20 % of the patients and further increased the mean CFE cycle length (110 ± 31 to 125 ± 39 ms; P = 0.0033) and decreased the DF (6.0 ± 0.8 to 5.7 ± 0.7 Hz; P = 0.0013) within the CS. CONCLUSIONS: The presence of localized CFE sites with a predilection for particular LA regions after a representative linear LA ablation could provide the optimal sites for selective substrate modification of the atrial fibrillation substrate in patients with PsAF.
Authors: Michel Haïssaguerre; Prashanthan Sanders; Mélèze Hocini; Yoshihide Takahashi; Martin Rotter; Frederic Sacher; Thomas Rostock; Li-Fern Hsu; Pierre Bordachar; Sylvain Reuter; Raymond Roudaut; Jacques Clémenty; Pierre Jaïs Journal: J Cardiovasc Electrophysiol Date: 2005-11
Authors: Michel Haïssaguerre; Mélèze Hocini; Prashanthan Sanders; Frederic Sacher; Martin Rotter; Yoshihide Takahashi; Thomas Rostock; Li-Fern Hsu; Pierre Bordachar; Sylvain Reuter; Raymond Roudaut; Jacques Clémenty; Pierre Jaïs Journal: J Cardiovasc Electrophysiol Date: 2005-11
Authors: R J Hunter; T J Berriman; I Diab; V Baker; M Finlay; L Richmond; E Duncan; R Kamdar; G Thomas; D Abrams; M Dhinoja; S Sporton; M J Earley; R J Schilling Journal: Heart Date: 2010-05-18 Impact factor: 5.994
Authors: Mélèze Hocini; Isabelle Nault; Matthew Wright; George Veenhuyzen; Sanjiv M Narayan; Pierre Jaïs; Kang-Teng Lim; Sébastien Knecht; Seiichiro Matsuo; Andrei Forclaz; Shinsuke Miyazaki; Amir Jadidi; Mark D O'Neill; Frédéric Sacher; Jacques Clémenty; Michel Haïssaguerre Journal: J Am Coll Cardiol Date: 2010-03-09 Impact factor: 24.094
Authors: Claude S Elayi; Luigi DI Biase; Rong Bai; J David Burkhardt; Prasant Mohanty; Javier Sanchez; Pasquale Santangeli; Richard Hongo; G Joseph Gallinghouse; Rodney Horton; Shane Bailey; Jason Zagrodzky; Salwa Beheiry; Andrea Natale Journal: J Cardiovasc Electrophysiol Date: 2011-06-21
Authors: Michel Haïssaguerre; Mélèze Hocini; Yoshihide Takahashi; Mark D O'Neill; Andrej Pernat; Prashanthan Sanders; Anders Jonsson; Martin Rotter; Frederic Sacher; Thomas Rostock; Seiichiro Matsuo; Leonardo Arantés; Kang Teng Lim; Sébastien Knecht; Pierre Bordachar; Julien Laborderie; Pierre Jaïs; George Klein; Jacques Clémenty Journal: J Cardiovasc Electrophysiol Date: 2007-04
Authors: Jérôme Kalifa; Kazuhiko Tanaka; Alexey V Zaitsev; Mark Warren; Ravi Vaidyanathan; David Auerbach; Sandeep Pandit; Karen L Vikstrom; Robert Ploutz-Snyder; Arkadzi Talkachou; Felipe Atienza; Gérard Guiraudon; José Jalife; Omer Berenfeld Journal: Circulation Date: 2006-02-07 Impact factor: 29.690
Authors: Yoshihide Takahashi; Mark D O'Neill; Mélèze Hocini; Rémi Dubois; Seiichiro Matsuo; Sébastien Knecht; Srijoy Mahapatra; Kang-Teng Lim; Pierre Jaïs; Anders Jonsson; Frédéric Sacher; Prashanthan Sanders; Thomas Rostock; Pierre Bordachar; Jacques Clémenty; George J Klein; Michel Haïssaguerre Journal: J Am Coll Cardiol Date: 2008-03-11 Impact factor: 24.094