Catheter Ablation of Longstanding Persistent Atrial Fibrillation

Optimal Ablation Endpoint for Longstanding Persistent Atrial Fibrillation: a Randomized Prospective Study

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.

Inclusion Criteria:

• Patients with longstanding persistent atrial fibrillation (lasting for>1 year)
• Exhibited refractoriness to at least one antiarrhythmic drug
• Left atrial diameter <=60mm

Exclusion Criteria:

• Patients with uncontrolled congestive heart failure
• Having significant valvular disease and/or prosthetic heart valve(s)
• With myocardial infarction or stroke within 6 months of screening
• With Significant congenital heart disease;ejection fraction was <40% measured by echocardiography
• Allergic to contrast media
• Contraindication to warfarin or heparin
• Severe pulmonary disease e.g. restrictive pulmonary disease
• Chronic obstructive disease (COPD)
• Left atrial (LA) thrombus measured by pre-procedure transesophageal echocardiography
• Having any contraindication to right or left sided heart catheterization
• Poor general health
• Life expectancy less than 6 months