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

J Cardiovasc Electrophysiol. 2023 Dec;34(12):2461-2471. doi: 10.1111/jce.16047. Epub 2023 Sep 13.


Introduction: Treatment 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.

Methods: A 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.

Results: After 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).

Conclusions: FAAM ablation showed a promising decrease in the recurrence rate of atrial tachyarrhythmia in patients with recurrent AF during a 1-year follow-up.

Keywords: FAAM; atrial fibrillation; non-PV foci; novel ablation strategy; recurrent AF; refractory AF.

MeSH terms

  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / surgery
  • Catheter Ablation* / adverse effects
  • Catheter Ablation* / methods
  • Follow-Up Studies
  • Humans
  • Muscles / surgery
  • Pulmonary Veins* / surgery
  • Recurrence
  • Retrospective Studies
  • Tachycardia
  • Treatment Outcome
  • Vena Cava, Superior