Abstract 15636: Impact of CFAEs Ablation in Long Standing Persistent AF Patients: Long Term Follow Up from a Randomized Study

Introduction: Several metanalysis have shown that complex fractionated atrial electrograms(CFAEs) ablation in addition to standard pulmonary vein isolation (PVI) increases freedom from AF in patients with long standing persistent AF after a single ablation procedure. However, data in the literature are limited to 18 months follow up and no data exist on the very long term follow up. We aimed to compare ablation strategies including PVI and CFAEs with other strategies including ablation of non-PV triggers as disclosed by isoproterenol challenge at a very long term follow (at least 3 years). Methods: One hundred forty-nine consecutive patients undergoing ablation for long standing persistent AF were divided to: pulmonary vein isolation (PVI), (Group 1), PVI plus ablation of CFAEs, (group 2) and PVI followed by CFAEs and by non PV triggers ablation as disclosed by high dose of isoproterenol challenge (group 3). Patients were given event recorders and followed up at 3, 6, 9, 12, and every three months thereafter for a minimum of three years. Results: Group 1 consisted of 48 patients, group 2 consisted of 49 patients and group 3 consisted of 50 patients. Baseline characteristics were not significantly different across the groups. At 18 months success rate was 40% group 1, 61% in group 2, and 80% in group 3. At end of 30±6 months of follow-up, 9 (19%) in group 1, 10(20%) in group 2, and 31(62%) in group 3 were arrhythmia free off-AAD (log-rank p Conclusion: In patients with non paroxysmal AF in addition to PVI, CFAEs ablation and non PV triggers ablation increase the outcome at the long-term follow. The benefit of CFAEs ablation alone disappears at the long term follow up.