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Optimal endpoint for catheter ablation of longstanding persistent atrial fibrillation: A randomized clinical trial
Author(s) -
Wang Yuanlong,
Liu Xu,
Zhang Yu,
Jiang Weifeng,
Zhou Li,
Qin Mu,
Zhang Daoliang,
Zhang Xiaodong,
Wu Shaohui,
Xu Kai
Publication year - 2018
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13221
Subject(s) - medicine , ablation , atrial fibrillation , atrial tachycardia , cardiology , pulmonary vein , catheter ablation , sinus rhythm , clinical endpoint , randomized controlled trial
Background In longstanding persistent atrial fibrillation (LPeAF), the ideal endpoint of ablation remains to be determined. This study was to explore the value of pursuing AF termination or no with the same strategy during ablation on the long‐term outcomes in patients with LPeAF. Methods Utilized “CCL” strategy is a fixed ablation approach consisting of circumferential pulmonary vein antrum isolation, ablation of complex fractionated atrial electrogram, and linear ablation between two anatomical structures (the mitral isthmus, left atrial roof). Note that 400 patients were randomized to group A (technical endpoint) and group B (pursuing AF termination). Results A group with technical endpoint had lower rate of acute AF termination (AF→sinus rhythm, 3.5% vs 18.1%; AF→atrial tachycardia, 23.7% vs 44.7%; P < 0.01) and shorter duration of ablation (164.9 ± 20.8 vs 223.4 ± 24.9, P < 0.01), radiofrequency delivery time (69.8 ± 18.1 vs 102.2 ± 26.3, P < 0.01), and x‐ray exposure time (18.2 ± 8.8 vs 27.9 ± 12.4, P < 0.01) than those in B group (pursuing AF termination). During follow‐up, freedom from atrial arrhythmias did not differ between the two groups after a single ablation procedure (46.5% vs 54.3%, P=0.12) and the final ablation procedure (60.1% vs 65.8%, P = 0.24). Conclusion In patients of LPeAF, pursuing AF termination during ablation was associated with similar long‐term clinical outcome compared to that with technical endpoint. Ablation to termination is not the best strategy during ablation.