Efficacy of catheter ablation of focal sources in persistent atrial fibrillation

Introduction Recent studies suggest that atrial fibrillation (AF) is maintained by electrical activity arising from focal sources. We sought to test whether catheter ablation that targets focal sources can improve on current ablation protocols for persistent AF. Methods and results In patients with...

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Published in:Journal of Cardiovascular Electrophysiology Vol. 29; no. 4; pp. 559 - 565
Main Authors: Takahashi, Yoshihide, Yamashita, Syu, Suzuki, Masahito, Yabe, Kento, Hirao, Kenzo
Format: Journal Article
Language:English
Published: United States Wiley 01.04.2018
Wiley Subscription Services, Inc
Subjects:
Action Potentials
Aged
Anti-Arrhythmia Agents
Arrhythmia
Atrial Fibrillation
Atrium
Cardiac arrhythmia
Catheter Ablation
Catheters
Electrophysiologic Techniques, Cardiac
Female
Fibrillation
focal sources
Heart Rate
Humans
Male
mapping
Middle Aged
Progression-Free Survival
Pulmonary Veins
Radiofrequency ablation
Recurrence
Retrospective Studies
Risk Assessment
Risk Factors
rotors
Tachyarrhythmia
Tachycardia
Time Factors
atrial fibrillation
mapping
rotors
catheter ablation
focal sources
ISSN:1045-3873, 1540-8167, 1540-8167
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Summary:Introduction Recent studies suggest that atrial fibrillation (AF) is maintained by electrical activity arising from focal sources. We sought to test whether catheter ablation that targets focal sources can improve on current ablation protocols for persistent AF. Methods and results In patients with persistent AF whose AF did not terminate with pulmonary vein (PV) isolation, the left atrium was mapped with a 20‐pole high‐density mapping catheter using CARTO®3 navigation. If a site demonstrated centrifugal activation over at least three consecutive cycles, it was deemed a focal source and ablated. If AF remained, defragmentation was performed until AF was terminated. Freedom from atrial tachyarrhythmia was compared between the study patients and propensity score matched historical controls who had undergone conventional stepwise ablation. Of the 68 study patients, 2.9 ± 1.9 focal sources were identified in 60 patients. Focal sources displayed transient centrifugal activation patterns for a median of six consecutive cycles. Total radiofrequency duration was shorter in the study group (62 ± 16 minutes vs. 75 ± 24 minutes, P = 0.0003). During a 1‐year follow‐up period, 39 (57%) and 26 (38%) patients were free from atrial tachyarrhythmias in the absence of antiarrhythmic drugs in the study and control groups, respectively (hazard ratio: 1.85, 95% confidence interval: 1.17–2.96, P = 0.009). Improvement of clinical outcome was mainly driven by a decrease in recurrence of atrial tachycardia in the study patients (22% vs. 40%, P = 0.047). Conclusion The results of this study suggest that focal sources are appropriate ablation targets in addition to the PVs in persistent AF.
Bibliography:Disclosures
Dr. Takahashi reports honoraria relevant to this topic from Biosense‐Webster and St. Jude Medical. Other authors: no disclosures.
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ISSN:1045-3873
1540-8167
1540-8167
DOI:10.1111/jce.13415