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Background  Little evidence exists regarding the endpoint and optimum approach to catheter ablation for long‐standing persistent atrial fibrillation ( LSPAF ). We examined the efficacy of pulmonary vein isolation ( PVI ) plus left atrium posterior wall isolation ( PWI ) and additional non‐ PV  trigger ablation using high‐dose isoproterenol for  LSPAF .    Methods  One‐hundred and fifty‐five patients (median  AF  duration, 36 months) underwent catheter ablation for  LSPAF ; After  PVI  plus  PWI , they underwent provocation of non‐ PV  triggers by high‐dose isoproterenol and were divided into 3 groups based on the results: group A,  PVI  plus  PWI  alone, without induced non‐ PV  triggers (single procedure: 105 patients, multiple procedures: 90 patients); group B, mappable non‐ PV  triggers demonstrated and ablated (single procedure: 41 patients, multiple procedures: 45 patients); group C, if non‐ PV  triggers were unmappable or could not be induced in repeated procedures, adjunctive complex fractionated atrial electrogram ablation was performed (single procedure: 9 patients, multiple procedures: 20 patients).    Results  The Kaplan‐Meier estimate of the 1‐year freedom from atrial tachyarrhythmias without antiarrhythmic drugs was 65% in all patients, (73%, 56%, and 11% in groups A, B, and C, respectively) after a single procedure, which improved to 86% in all patients (93%, 86%, and 53% in groups A, B, and C, respectively) after multiple procedures.    Conclusion  Even for  LSPAF , in approximately 60% of patients, non‐ PV  triggers were not elicited, and  PVI  plus  PWI  alone achieved good outcomes. Although the inducibility of non‐ PV  triggers was associated with recurrence of atrial tachyarrhythmias, additional non‐ PV  trigger ablation may improve the outcome after multiple procedures.

journal of arrhythmia

Pulmonary vein isolation plus left atrial posterior wall isolation and additional nonpulmonary vein trigger ablation using high‐dose isoproterenol for long‐standing persistent atrial fibrillation