Identifying the relationship between the non-PV triggers and the critical CFAE sites post-PVAI to curtail the extent of atrial ablation in longstanding persistent AF

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

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Relationship Between the Non-PV Triggers and the Critical CFAE Sites. Background: Complex fractionated atrial electrograms (CFAE) ablation has been performed in addition to pulmonary veins (PV) isolation to increase the success rate of atrial fibrillation (AF) ablation in patients with longstanding (LS) persistent AF. The mechanism underlying the clinical benefit of CFAE ablation remains, however, poorly understood. Objective: We compared the impact of CFAE ablation on the prevalence of non-PV atrial triggers inducing AF in 2 groups of patients with LS persistent AF. One group underwent PVAI alone, and the other group underwent PVAI plus CFAE ablation. In addition, we correlated the site of non-PV triggers with the presence of CFAE. Methods: A total of 98 consecutive patients with symptomatic drug refractory LS persistent AF presenting for ablation had a preablation electroanatomic CFAE map. Patients randomized to either isolation of the PVs and posterior wall (PVAI) (group I, n = 48 pts) or PVAI and biatrial ablation of CFAEs (group II, 50 pts). After ablation, infusion of isoproterenol up to 30 mcg/min was given to reveal non PV foci inducing AF. Those foci were mapped and correlated with CFAE regions and ablated. Results: A total of 19 patients (76%) with PV foci inducing AF were associated with either stable or transient CFAE after PVAI, respectively, in 12 patients (48%) and 7 patients (28%). A total of 20 (42%) non-PV triggers were observed in group I versus 5 (10%) in group II (P < 0.001) in 18 and 5 patients, respectively. After a mean f/u of 17.2 ± 5.2 months, 33 (69%) patients in group I and 36 (72%) patients in group II were in SR (P = NS). Conclusion: Non-PV triggers inducing AF post-PVAI were associated with the presence of stable or transient CFAE in 48% and 28% of cases, respectively, in LS persistent AF. CFAE ablation after PVAI was associated with a significantly higher elimination of those non-PV triggers. This suggests that at least part of the beneficial effect achieved by CFAE ablation reflects elimination of non-PV AF triggers.

Original languageEnglish (US)
Pages (from-to)1199-1205
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume22
Issue number11
DOIs
StatePublished - Nov 2011
Externally publishedYes

Fingerprint

Cardiac Electrophysiologic Techniques
Atrial Fibrillation
Veins
Pulmonary Veins
Isoproterenol

Keywords

  • atrial fibrillation
  • catheter ablation
  • complex fragmented atrial electrograms
  • nonpulmonary vein triggers
  • persistent atrial fibrillation
  • pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Identifying the relationship between the non-PV triggers and the critical CFAE sites post-PVAI to curtail the extent of atrial ablation in longstanding persistent AF. / Elayi, Claude S.; Di Biase, Luigi; Bai, Rong; Burkhardt, J. David; Mohanty, Prasant; Sanchez, Javier; Santangeli, Pasquale; Hongo, Richard; Gallinghouse, G. Joseph; Horton, Rodney; Bailey, Shane; Zagrodzky, Jason; Beheiry, Salwa; Natale, Andrea.

In: Journal of Cardiovascular Electrophysiology, Vol. 22, No. 11, 11.2011, p. 1199-1205.

Research output: Contribution to journalArticle

Elayi, CS, Di Biase, L, Bai, R, Burkhardt, JD, Mohanty, P, Sanchez, J, Santangeli, P, Hongo, R, Gallinghouse, GJ, Horton, R, Bailey, S, Zagrodzky, J, Beheiry, S & Natale, A 2011, 'Identifying the relationship between the non-PV triggers and the critical CFAE sites post-PVAI to curtail the extent of atrial ablation in longstanding persistent AF', Journal of Cardiovascular Electrophysiology, vol. 22, no. 11, pp. 1199-1205. https://doi.org/10.1111/j.1540-8167.2011.02122.x
Elayi, Claude S. ; Di Biase, Luigi ; Bai, Rong ; Burkhardt, J. David ; Mohanty, Prasant ; Sanchez, Javier ; Santangeli, Pasquale ; Hongo, Richard ; Gallinghouse, G. Joseph ; Horton, Rodney ; Bailey, Shane ; Zagrodzky, Jason ; Beheiry, Salwa ; Natale, Andrea. / Identifying the relationship between the non-PV triggers and the critical CFAE sites post-PVAI to curtail the extent of atrial ablation in longstanding persistent AF. In: Journal of Cardiovascular Electrophysiology. 2011 ; Vol. 22, No. 11. pp. 1199-1205.
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abstract = "Relationship Between the Non-PV Triggers and the Critical CFAE Sites. Background: Complex fractionated atrial electrograms (CFAE) ablation has been performed in addition to pulmonary veins (PV) isolation to increase the success rate of atrial fibrillation (AF) ablation in patients with longstanding (LS) persistent AF. The mechanism underlying the clinical benefit of CFAE ablation remains, however, poorly understood. Objective: We compared the impact of CFAE ablation on the prevalence of non-PV atrial triggers inducing AF in 2 groups of patients with LS persistent AF. One group underwent PVAI alone, and the other group underwent PVAI plus CFAE ablation. In addition, we correlated the site of non-PV triggers with the presence of CFAE. Methods: A total of 98 consecutive patients with symptomatic drug refractory LS persistent AF presenting for ablation had a preablation electroanatomic CFAE map. Patients randomized to either isolation of the PVs and posterior wall (PVAI) (group I, n = 48 pts) or PVAI and biatrial ablation of CFAEs (group II, 50 pts). After ablation, infusion of isoproterenol up to 30 mcg/min was given to reveal non PV foci inducing AF. Those foci were mapped and correlated with CFAE regions and ablated. Results: A total of 19 patients (76{\%}) with PV foci inducing AF were associated with either stable or transient CFAE after PVAI, respectively, in 12 patients (48{\%}) and 7 patients (28{\%}). A total of 20 (42{\%}) non-PV triggers were observed in group I versus 5 (10{\%}) in group II (P < 0.001) in 18 and 5 patients, respectively. After a mean f/u of 17.2 ± 5.2 months, 33 (69{\%}) patients in group I and 36 (72{\%}) patients in group II were in SR (P = NS). Conclusion: Non-PV triggers inducing AF post-PVAI were associated with the presence of stable or transient CFAE in 48{\%} and 28{\%} of cases, respectively, in LS persistent AF. CFAE ablation after PVAI was associated with a significantly higher elimination of those non-PV triggers. This suggests that at least part of the beneficial effect achieved by CFAE ablation reflects elimination of non-PV AF triggers.",
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T1 - Identifying the relationship between the non-PV triggers and the critical CFAE sites post-PVAI to curtail the extent of atrial ablation in longstanding persistent AF

AU - Elayi, Claude S.

AU - Di Biase, Luigi

AU - Bai, Rong

AU - Burkhardt, J. David

AU - Mohanty, Prasant

AU - Sanchez, Javier

AU - Santangeli, Pasquale

AU - Hongo, Richard

AU - Gallinghouse, G. Joseph

AU - Horton, Rodney

AU - Bailey, Shane

AU - Zagrodzky, Jason

AU - Beheiry, Salwa

AU - Natale, Andrea

PY - 2011/11

Y1 - 2011/11

N2 - Relationship Between the Non-PV Triggers and the Critical CFAE Sites. Background: Complex fractionated atrial electrograms (CFAE) ablation has been performed in addition to pulmonary veins (PV) isolation to increase the success rate of atrial fibrillation (AF) ablation in patients with longstanding (LS) persistent AF. The mechanism underlying the clinical benefit of CFAE ablation remains, however, poorly understood. Objective: We compared the impact of CFAE ablation on the prevalence of non-PV atrial triggers inducing AF in 2 groups of patients with LS persistent AF. One group underwent PVAI alone, and the other group underwent PVAI plus CFAE ablation. In addition, we correlated the site of non-PV triggers with the presence of CFAE. Methods: A total of 98 consecutive patients with symptomatic drug refractory LS persistent AF presenting for ablation had a preablation electroanatomic CFAE map. Patients randomized to either isolation of the PVs and posterior wall (PVAI) (group I, n = 48 pts) or PVAI and biatrial ablation of CFAEs (group II, 50 pts). After ablation, infusion of isoproterenol up to 30 mcg/min was given to reveal non PV foci inducing AF. Those foci were mapped and correlated with CFAE regions and ablated. Results: A total of 19 patients (76%) with PV foci inducing AF were associated with either stable or transient CFAE after PVAI, respectively, in 12 patients (48%) and 7 patients (28%). A total of 20 (42%) non-PV triggers were observed in group I versus 5 (10%) in group II (P < 0.001) in 18 and 5 patients, respectively. After a mean f/u of 17.2 ± 5.2 months, 33 (69%) patients in group I and 36 (72%) patients in group II were in SR (P = NS). Conclusion: Non-PV triggers inducing AF post-PVAI were associated with the presence of stable or transient CFAE in 48% and 28% of cases, respectively, in LS persistent AF. CFAE ablation after PVAI was associated with a significantly higher elimination of those non-PV triggers. This suggests that at least part of the beneficial effect achieved by CFAE ablation reflects elimination of non-PV AF triggers.

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KW - atrial fibrillation

KW - catheter ablation

KW - complex fragmented atrial electrograms

KW - nonpulmonary vein triggers

KW - persistent atrial fibrillation

KW - pulmonary vein isolation

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