Publication: A new approach for catheter ablation of atrial fibrillation: Mapping of the electrophysiologic substrate
Issued Date
2004-06-02
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ISSN
07351097
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2-s2.0-2542488122
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of the American College of Cardiology. Vol.43, No.11 (2004), 2044-2053
Suggested Citation
Koonlawee Nademanee, John McKenzie, Erol Kosar, Mark Schwab, Buncha Sunsaneewitayakul, Thaveekiat Vasavakul, Chotikorn Khunnawat, Tachapong Ngarmukos A new approach for catheter ablation of atrial fibrillation: Mapping of the electrophysiologic substrate. Journal of the American College of Cardiology. Vol.43, No.11 (2004), 2044-2053. doi:10.1016/j.jacc.2003.12.054 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/21625
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Title
A new approach for catheter ablation of atrial fibrillation: Mapping of the electrophysiologic substrate
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Abstract
Objectives We sought to test the hypothesis that complex fractionated electrograms (CFAEs) recorded during atrial fibrillation (AF) could be used as target sites for catheter ablation of AF. Background Mapping of AF in humans has shown that areas of CFAEs correlate with areas of slowed conduction and pivot points of reentrant wavelets. We hypothesized that such areas of CFAEs could be identified in patients with AF and might serve as target sites for catheter ablation to maintain sinus rhythm. Methods The study population included 121 patients (29 females; mean age, 63 years) with refractory AF (57 paroxysmal, 64 chronic). All patients underwent nonfluoroscopic electroanatomic mapping (CARTO) during AF. Using CARTO, the biatrial replica, displayed in a three-dimensional color-coded voltage map, was created during AF, and areas associated with CFAEs were identified. Radiofrequency ablation of the area with CFAEs was performed, aiming to eliminate CFAE and/or convert to sinus rhythm. Results Complex fractionated atrial electrograms were found in seven of nine regions of both atria, but were mainly confined to the interatrial septum, pulmonary veins, roof of left atrium, and left posteroseptal mitral annulus and coronary sinus ostium. Ablations of the areas associated with CFAEs resulted in termination of AF without external cardioversion in 115 of the 121 patients (95%); 32 (28%) required concomitant ibutilide treatment. At the one-year follow-up, 110 (91%) patients were free of arrhythmia and symptoms, 92 after one ablation and 18 after two. Conclusions Areas with CFAEs represent a defined electrophysiologic substrate and are ideal target sites for ablations to eliminate AF and maintain normal sinus rhythm. © 2004 by the American College of Cardiology Foundation.