Selective CFAE targeting for atrial fibrillation study (SELECT AF): Clinical rationale, design, and implementation

Atul Verma, Prashanthan Sanders, Laurent MacLe, Jean Champagne, Girish M. Nair, Hugh Calkins, David J. Wilber

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)

Abstract

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)

Original languageEnglish
Pages (from-to)541-547
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume22
Issue number5
DOIs
Publication statusPublished or Issued - 1 May 2011

Keywords

  • atrial fibrillation
  • clinical trial
  • complex fractionated atrial electrograms
  • electroanatomical mapping
  • left atrium
  • radiofrequency ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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