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Impact of pre-existent areas of complex fractionated atrial electrograms on outcome after pulmonary vein isolation

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Abstract

Background

Atrial fibrillation (AF) drivers outside pulmonary veins (PV) may account for failure after PV isolation. The aim of this study was to characterize pre-existent areas of complex fractionated atrial electrograms (CFAEs) recorded in right atrium (RA) and in coronary sinus (CS) during catheter-based PV isolation and to assess their relation to outcome.

Methods and results

With a tricuspid annulus and CS mapping, CFAEs were retrospectively identified in consecutive patients who underwent PV isolation. Of 224 patients, 161 were found to have CFAEs (81%). No clinical variable was found to be predictive of CFAEs presence. By Kaplan–Meier analysis, following a median follow-up of 23.7 months after a single ablation procedure, 62.8% of patients in the CFAEs(+) group and 85.4% of those in the CFAEs(−) group were free from recurrent atrial tachyarrhythmias (p = 0.013). Multivariable Cox regression analysis showed that CFAEs evidence was an independent predictor of recurrence (p = 0.007).

Conclusions

Pre-existent CFAEs, that can be easily identified in RA and CS during PV isolation, are a powerful independent predictor for AF recurrence. This finding may be helpful for refining AF ablation strategies.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Cardiology, Policlinico Universitario “Tor Vergata”, Viale Oxford, 81, 00133, Roma, Italy

    Giovanni B. Forleo, Lucia De Luca, Luca Santini & Francesco Romeo

  2. Arrhythmia and Electrophysiology Center, St. Ambrogio Clinical Institute, Milan, Italy

    Massimo Mantica

  3. Cardiac Arrhythmia and Heart Failure Research Center, St. Camillo-Forlanini Hospital, Catholic University of Sacred Heart, Rome, Italy

    Antonio Dello Russo, Michela Casella, Gemma Pelargonio & Claudio Tondo

Authors
  1. Giovanni B. Forleo
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  2. Massimo Mantica
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  3. Lucia De Luca
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  4. Antonio Dello Russo
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  9. Claudio Tondo
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Correspondence to Giovanni B. Forleo.

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Forleo, G.B., Mantica, M., De Luca, L. et al. Impact of pre-existent areas of complex fractionated atrial electrograms on outcome after pulmonary vein isolation. J Interv Card Electrophysiol 21, 227–234 (2008). https://doi.org/10.1007/s10840-008-9240-3

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  • DOI: https://doi.org/10.1007/s10840-008-9240-3

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