A novel ablation strategy for recurrent atrial fibrillation: Fractionated signal area in the atrial muscle ablation 1‐year follow‐up

Abstract

AbstractIntroductionTreatment of recurrent atrial fibrillation (AF) is sometimes challenging due to non‐pulmonary vein (PV) foci. Fractionated signal area in the atrial muscle (FAAM) is a valid predictor of the location of non‐PV foci. FAAM ablation has the potential to decrease the recurrence rate of atrial tachyarrhythmia in patients with recurrent AF. We compared the clinical impact of FAAM ablation for recurrent AF, using 1 year follow up date.MethodsA total of 230 consecutive patients with symptomatic recurrent AF who underwent catheter ablation specifically targeting non‐PV foci as FAAM‐guided ablation (n = 113) and non‐FAAM‐guided ablation (n = 117) were retrospectively analyzed. FAAM was assigned a parameter (peaks slider, which indicates the number of components of fractionated signals), ranging from 1 to 15, indicating the location of the FAAM (1: largest, 15: smallest). FAAM‐guided ablation was performed by ablating FAAM until none inducibility of non‐PV foci. On the other hand, non‐FAAM‐guided ablation was performed via linear ablation, complex fractionated atrial electrogram ablation, superior vena cava isolation, and focal ablation according to the location of the non‐PV foci. The RHYTHMIA system was used to perform all the procedures. The primary endpoints were AF recurrence, atrial flutter, and/or atrial tachycardia.ResultsAfter a 1‐year follow up, freedom from atrial tachyarrhythmia was achieved in 90.3% and 75.2% of patients in the FAAM and non‐FAAM groups, respectively (hazard ratio = 0.438 [95% confidence interval: 0.243–0.788], p  =  .005).ConclusionsFAAM ablation showed a promising decrease in the recurrence rate of atrial tachyarrhythmia in patients with recurrent AF during a 1‐year follow‐up.