Box Isolation of Fibrotic Areas (BIFA): A Patient‐Tailored Substrate Modification Approach for Ablation of Atrial Fibrillation

• DOI: 10.1111/jce.12870
• Publication Date: 2015-10-29T10:01:33Z
• Authors: HANS KOTTKAMP; JAN BERG; RODERICH BENDER; ANDREAS RIEGER; DOREEN SCHREIBER
• Keywords: Atrial tachycardia

Substrate Modification BIFA in AF Ablation Background Catheter ablation strategies beyond pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF) are less well defined. Increasing clinical data indicate that fibrosis is a critical common left (LA) substrate patients (pts). Objective We applied new modification concept according to the individual fibrotic as estimated from electroanatomic voltage mapping (EAVM) 41 pts undergoing catheter AF. Results First, EAVM during sinus rhythm was done redo cases 10 with paroxysmal despite durable PVI. Confluent low‐voltage areas (LVA) were found all and targeted circumferential isolation, so‐called box (BIFA). This strategy led stable 9/10 transferred prospectively first procedures 31 nonparoxysmal In 13 (42%), no LVA (<0.5 mV) identified, only PVI performed. 18 (58%), additional (posterior 5, anterior 7, posterior plus 1 due diffuse fibrosis). Mean follow‐up 12.5 ± 2.4 months. Single‐procedure freedom AF/atrial tachycardia achieved 72.2% 83.3% 1.17 procedures/patient. Conclusions approximately 40% AF, substantial alone showed high success rate. 60% individually localized identified could be successfully strategy.