The efficacy of ablation based on the combined use of the dominant frequency and complex fractionated atrial electrograms for non-paroxysmal atrial fibrillation

Background: This study aimed to evaluate an approach for an endpoint of non-inducibility using a combined high-dominant frequency (DF) and continuous complex fractionated atrial electrogram (CFAE) ablation following circumferential pulmonary vein isolation (PVI) in a sequential fashion, including linear ablation as compared to PVI alone. Methods and results: A total of 84 non-paroxysmal patients with atrial fibrillation (AF) were investigated retrospectively. The AF patients were divided into two groups: patients with PVI following a combined high-DF and continuous CFAE ablation with linear ablation (substrate modification group, n = 59) and those with PVI alone (n = 25). DF sites of >= 8 Hz and then continuous CFAE sites defined by fractionation intervals of <= 50 ms were modified after PVI. The ablation endpoint was non-inducibility. Atrial tachyarrhythmias (ATs) could not be induced in 54 of 59 (92%) patients after a sequential ablation, and in 18 of 25 (64%) with PVI alone. The ATs freedom without antiarrhythmic drugs in the substrate modification group was significantly greater than that in those with PVI alone after 1 procedure during 12 months of follow-up (78.6% vs. 53.8%, log-rank test p = 0.039). Conclusion: This sequential approach using a substrate based ablation was associated with a better clinical long-term outcome as compared to PVI alone. (C) 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.