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Selective CFAE Targeting for Atrial Fibrillation Study (SELECT AF): Clinical Rationale, Design, and Implementation.
MedLine Citation:
PMID:  21087332     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
SELECT AF Methodology & Rationale. Background: Adjuvant ablation of complex fractionated atrial electrograms (CFAE) in addition to pulmonary vein isolation (PVI) likely improves procedural outcome compared to PVI alone, particularly in patients with persistent atrial fibrillation (AF). However, CFAE regions can be extensive, occasionally requiring a large amount of extra ablation. Some CFAE regions may also represent passive wavefront collision and may not require ablation. Thus, there is interest in identifying more selective CFAE sites that are critical to AF perpetuation, minimizing the amount of adjuvant ablation that must be performed. Objective: The SELECT AF study is a prospective, multicenter, randomized trial comparing a strategy of PVI plus generalized CFAE ablation versus a strategy of PVI plus selective CFAE ablation, focusing on regions of continuous electrical activity (CEA). The primary efficacy endpoint is freedom from atrial arrhythmia at 1 year and the primary safety endpoint is total radiofrequency (RF) delivery time per procedure. Methods: Patients undergoing a first time ablation procedure for symptomatic persistent AF will be included. Patients with permanent AF or with left atrial size ≥55 mm will be excluded. Patients will all receive PVI at the time of their ablation, but will be randomized 1:1 to receive adjuvant CFAE ablation using the traditional "generalized" approach, or a "selective" approach targeting only CEA regions. Both strategies will be guided by automated mapping algorithms. This study will enroll a minimum of 80 evaluable subjects; 40 in each randomization group. Conclusions: SELECT AF is a randomized trial in patients with persistent AF to evaluate the efficacy of selective versus generalized CFAE ablation in addition to traditional PVI. (J Cardiovasc Electrophysiol, Vol. 22, pp. 541-547 May 2011).
Authors:
Atul Verma; Prashanthan Sanders; Laurent Macle; Jean Champagne; Girish M Nair; Hugh Calkins; David J Wilber
Publication Detail:
Type:  Journal Article     Date:  2010-11-18
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  22     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  541-7     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley Periodicals, Inc.
Affiliation:
Southlake Regional Health Centre, Newmarket, Ontario, Canada Royal Adelaide Hospital, Adelaide, South Australia, Australia Montreal Heart Institute, Montreal, Quebec, Canada Institut de Cardiologie et Pneumologie de l'Université Laval, Quebec City, Quebec, Canada Hamilton Health Sciences Centre, Hamilton, Ontario, Canada Johns Hopkins University Hospital, Baltimore, Maryland, USA Loyola University Medical Center, Maywood, Illinois, USA.
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