Background: Results of
Complex Fractionated Atrial Electrograms (CFAE) ablation in atrial fibrillation
(AF) are conflicting, partially due to the subjectivity of visual analysis.
CFAE algorithms provided by 3D mapping systems lack selectivity. We sought to
demonstrate the improved selectivity of a new CFAE CARTO® Shortest Complex
Interval (SCI) algorithm setting compared to the traditional nominal setting.
Methods: 32 patients (60.4 ± 12.7 years) with paroxysmal (n=3), persistent (n=16) or
permanent (n=13) AF (duration=56 ± 65 months) underwent visual CFAE
ablation, while CFAE maps of left atrium (LA) were drawn. Maps were further
reanalyzed with two different settings: nominal (SCI 60-120 ms 0.05-0.15mV) vs.
customized setting (SCI 30-40ms 0,04-0.15mV). Automatically detected areas of
CFAE (CARTO-CFAE) were measured and compared with the visually targeted areas
(ablation point = 60 mm2) to assess their accuracy to define CFAE areas of
Results: AF was terminated by ablation
in 30 patients (93.7%). With the new CARTO SCI setting, both CARTO-CFAE areas
and ablated proportions outside CFAE areas were reduced (30.6±20.5 cm2 vs. 68.8±24.5 cm2, p < 0.0001,
and 1.86±1.82 % vs. 3±3%, p =0.003), while ablation surface inside CARTO-CFAE areas
was larger than with the nominal setting (38.2±19.6% vs. 20.4±17.5
%, p = 0.008).
Conclusion: This new CFAE algorithm
setting is significantly more selective than the nominal one, and focuses on
visually ablated areas leading to a high AF termination rate.
Credits: Julien Seitz; Jérôme Horvilleur; Jérôme Lacotte; Yamina Mouhoub; Fiorella Salerno; Anouska Moynagh; Darach O h-Ici; Mehran Monchi; Laurence Curel; Andre Pisapia