Catheter ablation of atrial fibrillation guided by complex fractionated atrial electrogram mapping with or without pulmonary vein isolation

Pulmonary vein isolation (PVI) was the main strategy for catheter ablation of atrial fibrillation (AF) until a remarkable report was published by Nademanee et al. in 2004. The ablation targeting complex fractionated atrial electrograms (CFAE) achieved not only a high rate of AF termination but also excellent outcomes in both paroxysmal and persistent AF without isolating pulmonary veins. AF is thought to be caused by random or spiral reentry, as the fixed circuit to maintain AF may not exist, although the CFAE-guided ablation strategy is based on the theory that AF is not entirely random. CFAEs play an important role in identifying AF substrates, and have temporal and spatial stability, thus representing desirable targets for AF ablation; however, CFAE-guided ablation has not been fully replicated by others. In reports showing that CFAE ablation did not yield a good outcome either alone or combined with PVI, the AF termination rates were extremely low. Although AF termination is not mandatory in CFAE-ablation, terminating AF in the majority of patients appears to be necessary to yield good outcomes; therefore, this review will discuss AF ablation guided by CFAE with or without PVI, with particular emphasis given to practical aspects of achieving AF termination. (C) 2012 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.