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This randomized prospective study compared three ablation strategies in patients with longstanding persistent atrial fibrillation (LPeAF). It also explored the best procedural endpoint from among the following: circumferential pulmonary vein isolation (PVI)+left atrial (LA) linear lesions (roof line, mitral isthmus)+complex fractionated atrial electrogram (CFAE) ablation, PVI+LA linear lesions +cavotricuspid isthmus (CTI) ablation +CFAE ablation, and PVI+CFAE ablation.
Patients were randomized into three ablation groups: group A (n=100): PVI+LA linear ablation (roof line and mitral isthmus) +CFAE ablation; group B (n=100): PVI+linear ablation (roof line, mitral isthmus, and CTI) +CFAE ablation; group C (n=100), PVI+CFAE ablation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PVI+LA linear ablation +CFAE ablation | Active Comparator | The ablation procedure for atrial fibrillation guided by CARTO system, including PVI, LA linear ablation (roof line and mitral isthmus)and CFAE ablation. |
|
| PVI+linear ablation +CFAE ablation | Active Comparator | The ablation procedure for atrial fibrillation guided by CARTO system, including PVI,roof line and mitral isthmus,cavotricuspid isthmus abaltion and CFAE ablation. |
|
| PVI+CFAE ablation | Active Comparator | The ablation procedure for atrial fibrillation guided by CARTO system, including PVI and CFAE ablation. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PVI | Procedure | PVI was the complete isolation of all PVs, which was confirmed by entrance and/or exit block into or from the PV antra. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Time to first documented recurrence of atrial arrhythmias | Time to first documented recurrence of atrial arrhythmias after the first ablation procedure and after the final ablation procedure | 2-year follow-up |
| Measure | Description | Time Frame |
|---|---|---|
| Procedure duration at ablation | Minutes elapsed from the first puncture of the femoral vein to the removal of the last catheter | At the end of the first ablation procedure |
| Ablation time at ablation |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Yuanlong Mr Wang, MD | Contact | 08615800719348 | sdzhilong2011@163.com |
| Name | Affiliation | Role |
|---|---|---|
| Xu Mr Liu, MD | Shanghai Chest Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Shanghai chest hospital | Recruiting | Shanghai | Shanghai Municipality | 200030 | China |
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| ID | Term |
|---|---|
| D001281 | Atrial Fibrillation |
| ID | Term |
|---|---|
| D001145 | Arrhythmias, Cardiac |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D010335 | Pathologic Processes |
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| LA linear ablation | Procedure | LA linear ablation include mitral isthmus ablation and roof line ablation. Mitral isthmus ablation (from the mitral annulus to the left inferior PV) was performed first, followed by roof line ablation (between the right and left superior PVs). |
|
| CFAE ablation | Procedure | Ablation catheter was maintained in a stable position when the electrograms were being recorded for at least 5 s to avoid artifacts.The procedural endpoint of CFAEs was the complete elimination of fragmented atrial activity in local electrograms. |
|
| linear ablation | Procedure | Right atrial CTI ablation was performed during SR. |
|
| CARTO | Device | 3 dimensional mapping system |
|
Minutes elapsed from the onset of the first energy delivery to the end of the last energy delivery
| At the end of the first ablation procedure ] |
| Fluoroscopy time at ablation | Minutes of fluoroscopy used during the entire ablation procedure | At the end of the first ablation procedure |
| Complications | Incidence of peri-procedural complications including stroke, PV stenosis, cardiac perforation, esophageal injury, and death. | 2-year follow-up |
| Type of recurrent arrhythmia | Specific type of recurrent atrial arrhythmia | 2-year follow-up |
| Number of redo procedures | Number of redo procedures，including two or more procedures | 2-year follow-up |
| D013568 |
| Pathological Conditions, Signs and Symptoms |