Unanswered Questions in Complex Fractionated Atrial Electrogram Ablation

Pulmonary vein isolation has been accepted as potential target for ablation of paroxysmal atrial fibrillation (AF) given that the pulmonary veins are the main source of AF triggers. However, ablation strategies for persistent AF are less well defined. Mapping and ablation of complex fractionated atrial electrograms (CFAEs) is one strategy that has been proposed as a strategy for substrate modification although there is no consensus on their definition and procedural end points. Results of clinical studies have been conflicting. In this review, we aimed to discuss yesterday, today, and tomorrow of CFAEs ablation in persistent AF ablation.