Waveform Periodicity Analysis of Complex Fractionated Electrograms in Patients With Persistent Atrial Fibrillation

  • End date
    Dec 21, 2025
  • participants needed
  • sponsor
    Buddhist Tzu Chi General Hospital
Updated on 7 July 2022


Atrial fibrillation (AF) has been the most frequently occurring, sustained arrhythmia, which causes significant morbidity and mortality. AF may not always be a totally random process. It can be maintained by stable and rapid reentrant circuits resulting in fibrillary conduction throughout the atria. During mapping of AF, difficulty is frequently encountered during the identification of culprit sites and an analysis of the wave propagation particularly when the electrogram signals demonstrate wide temporal and spatial disparities. Catheter ablation targeting regions with fractionated potentials or high frequencies during AF, has been previously proposed as a treatment strategy. However, the benefit of adjunctive CFAE (complex fractionated atrial electrogram) ablation or linear ablation after successful PVI (pulmonary vein isolation) was controversial based on the recent data from the Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial Part II (STAR AF II) trial. Therefore, the optimal ablation strategy for persistent AF remains undetermined and an alternative approach has to be explored.


In this prospective trial, investigators will investigate the long-term efficacy of catheter ablation of non-paroxysmal AF, based on selective atrial substrate modification (e.g. wavefrom periodicity analysis, similarity, plus phase mapping) (1). The control group would be PV isolation alone. The primary end point is long-term recurrence of atrial arrhythmias. The secondary end points composite procedural termination, the safety of the procedure, recurrence of multiple procedures, and change of atrial and ventricular function after catheter ablation.

The inclusion criteria, exclusion criteria, stepwise catheter ablation procedures (PVI and then substrate modification), and the follow-up procedure are the same as current treatment approaches in patients with non-paroxysmal AF.

Condition Atrial Fibrillation, Persistent
Treatment Pulmonary vein isolation, Substrate ablation(PRISM based)
Clinical Study IdentifierNCT05426603
SponsorBuddhist Tzu Chi General Hospital
Last Modified on7 July 2022


Yes No Not Sure

Inclusion Criteria

Patients who sign the informed consent forms, and allow to be followed
Symptomatic AF refractory or intolerant to at least one Class 1 or 3 antiarrhythmic medication
Patients with persistent/permanent AF (sustained beyond seven days, or lasting less than seven days but necessitating pharmacologic or electrical cardioversion)
Patients with age equal or greater than 20 years old regardless of gender

Exclusion Criteria

The presence of a atrial or ventricular thrombus
Patients who are allergic to or unsuitable for use with the contrast media
Pregnant patients or patients who are unavailable to receive X-ray
Patients with renal insufficiency
Patients had autonomic nervous system disorder (e.g. respiratory apnea) or previous catheter ablation in the LA or MAZE procedure
Patients who do not need atrial substrate modification (patients with non-paroxysmal AF respond to PVI in terms of procedural termination of AF)
Patients with age less than 20 years old or greater than 90 years old regardless of gender
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