COMPARISON BETWEEN LINEAR VERSUS FOCAL ABLATION OF COMPLEX FRACTIONATED ATRIAL ELECTROGRAM IN NON-PAROXYSMAL ATRIAL FIBRILLATION: A PROSPECTIVE RANDOMIZED TRIAL

초록

Background: The efficacy of substrate modification in nonparoxysmal atrial fibrillation (AF) has been demonstrated inconsistently in the previous studies. Objective: We aimed to compare clinical outcomes between CFAE-guided focal (group A) and CFAE-guided linear ablation (group B). Methods: A total of 150 patients with non-paroxysmal AF were randomly assigned in a 1:1 ratio. The CFAE distribution was evaluated using the NavX customized software system. If AF was sustained or induced after pulmonary vein isolation, CFAEguided ablation was done in the left atrium (LA) and then right atrium (RA). CFAE-guided linear ablation was based on the conventional lines, and additionally comprised of segmental lines. Results: There were no significant differences in baseline characteristics between two groups. Noninducibility of AF or AT as procedural endpoint was achieved in 61.3% (group A) and 68.0% (group B). AF was not induced after PVI alone or with CTI ablation in 20.7% of total patients. Rhythm change defined as AT organization or sinus conversion during CFAE-guided ablation was observed in 62.7% (group A) and 75.0% (group B) (p=0.15). CFAE-guided ablation of RA was additionally performed in 45.9% (group A) and 37.8% (group B) (p=0.32). During mean 22.2±21.0 months follow-up, AF/AT recurred in 67.1% (group A) and 68.9% (group B) showing no statistical significance. Conclusion: Although there was no significant difference in clinical efficacy, CFAE-guided linear ablation showed more rhythm changes during the procedure compared to focal ablation of CFAEs, suggesting anatomically determined ablation with critical mass reduction may increase procedural outcome with less modification of substrate in patients with persistent AF.