Additional Ablation of Complex Fractionated Atrial Electrograms (CFAEs) After Pulmonary Vein Isolation (PVAI) in Patients With Atrial Fibrillation: A Meta-Analysis

Study Questions:

Does ablation of complex fractionated atrial electrograms (CFAEs) improve the efficacy of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) when performed after pulmonary vein antrum isolation (PVAI)?


This was a meta-analysis of seven studies that compared PVAI (n = 330) to PVAI plus CFAE ablation (n = 332) in a total of 662 patients with AF. The mean follow-up duration was 12-19 months. The primary outcome was freedom from AF in the absence of antiarrhythmic drug therapy after a single ablation procedure.


Additional RFCA of CFAEs did not improve efficacy in patients with paroxysmal AF. In patients with persistent AF, additional RFCA of CFAEs was associated with a significant relative improvement in efficacy of 35% compared to PVAI by itself.


Compared to PVAI by itself, the additional RFCA of CFAEs has incremental value in patients with persistent AF, but not in patients with paroxysmal AF.


CFAEs may be created by several different mechanisms, some of which play a role in maintaining AF and some of which do not. In paroxysmal AF, the pulmonary veins usually are the predominant source of the triggers and drivers of AF and, therefore, additional ablation of CFAEs is unnecessary, as reflected in the results of this meta-analysis. In contrast, in persistent AF, extrapulmonary vein mechanisms are common and CFAEs, albeit nonspecific, can identify important ablation sites.

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Heart Atria, Follow-Up Studies, Pulmonary Veins, Electrophysiologic Techniques, Cardiac, Catheter Ablation

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