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Editorials

The Substrate Maintaining Persistent Atrial Fibrillation

Michel Haïssaguerre, MD; Matthew Wright, MBBS, PhD; Mélèze Hocini, MD and Pierre Jaïs, MD

From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen, Bordeaux II, Bordeaux, France.

Correspondence to Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France. E-mail jacques.clementy@pu.u-bordeaux2.fr

Key Words: Editorials • ablation • fibrillation • arrhythmias • mapping

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Complex fractionated atrial electrogram (CFAE) ablation is one successful approach for treating patients with persistent atrial fibrillation (AF), along with strategies that incorporate pulmonary vein isolation and linear lesions. In this issue of Circulation: Arrhythmia and Electrophysiology, Oral et al¹ investigate the effect of right atrial CFAE focused ablation in patients with long-lasting persistent fibrillation. All patients had CFAE ablation in the left atrium and coronary sinus, and patients who did not convert to either sinus rhythm or atrial tachycardia were randomized to either additional right atrial CFAE ablation or to no further ablation. Patients were followed up for more than 1 year with similar outcomes in both groups, which suggests that right atrial CFAE ablation has no incremental benefit to targeting CFAE in the left atrium in persistent AF. Oral et al¹ do acknowledge some limitations in their study design, which may have given a false-negative result.

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Does the right atrial substrate play an important role in persistent AF, and how do we distinguish patients in whom the right atrium needs to be targeted as part of a catheter ablation strategy from those in whom the right atrium is unimportant?

	Does CFAE Represent the Atrial Substrate?

 
The Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society expert consensus document² on catheter and surgical ablation of AF suggests that areas with CFAEs potentially represent AF substrate sites, ie, the atrial, venous, and ganglionic tissue that is critical in perpetuating or "driving" AF. Is this widely held assumption that CFAEs are related to the . . . [Full Text of this Article]

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Randomized Evaluation of Right Atrial Ablation After Left Atrial Ablation of Complex Fractionated Atrial Electrograms for Long-Lasting Persistent Atrial Fibrillation

Hakan Oral, Aman Chugh, Eric Good, Thomas Crawford, Jean F. Sarrazin, Michael Kuhne, Nagib Chalfoun, Darryl Wells, Warangkna Boonyapisit, Nitesh Gadeela, Sundar Sankaran, Ayman Kfahagi, Krit Jongnarangsin, Frank Pelosi, Jr, Frank Bogun, and Fred Morady
Circ Arrhythm Electrophysiol 2008 1: 6-13. [Abstract] [Full Text]  

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