Putting CFAE on the Map

摘要

There have been significant advances in our understanding of the pathophysiology of atrial fibrillation (AF) over the last decade. These have led to ablation targeting the pulmonary veins being able to abolish AF in a significant proportion of patients with paroxysmal AF. However, some patients with paroxysmal and most patients with persistent of permanent AF still require considerable additional substrate modification to improve outcomes. The ideal additional method to modify the underlying substrate is not known. One proposed technique is the elimination of complex fractionated atrial electrograms (CFAE) that in selected studies has been shown to successfully treat AF.12 Fractionated and prolonged electrograms have been demonstrated to identify areas acting as pivot points, slowed conduction, anisotropy, localized circuits, or rotors, all of which are capable of sustaining reentry.3"5 Thus, accurately identifying such electrograms may allow a more targeted ablation strategy, thereby preventing the perpetuation of AF and improving outcomes#