Benefit of Left Atrial Roof Linear Ablation in Paroxysmal Atrial Fibrillation: A Prospective, Randomized Study

Background Isolation of the pulmonary veins ( PVs ) for the treatment of atrial fibrillation ( AF ) is often supplemented with linear lesions within the left atrium ( LA ). However, there are conflicting data on the effects of creating a roof line ( RL ) joining the superior PV s in paroxysmal atrial fibrillation (P AF ). Methods and Results A cohort of 120 patients with drug‐refractory P AF referred for ablation were prospectively randomized into 2 strategies: (1) PV isolation in combination with RL ablation (LA roof ablation [ LARA] ‐1: 59 patients) or (2) PV isolation ( LARA ‐2: 61 patients). Follow‐up was performed at 1, 3, and 6 months after the procedure and every 6 months thereafter. After a 3‐month blanking period, recurrence was defined as the ocurrence of any atrial tachyarrhythmia lasting ≥30 seconds. PV isolation was achieved in 89% and complete RL block in 81%. RF duration, fluoroscopy, and procedural times were slightly, but not significantly, longer in the LARA ‐1 group. After 15±10 months, there was no difference in the arrhythmia‐free survival after a single AF ablation procedure ( LARA ‐1: 59% vs. LARA ‐2: 56% at 12 months; log rank P =0.77). The achievement of complete RL block did not influence the results. The incidence of LA macroreentrant tachycardias was 5.1% in the LARA ‐1 group (n=3) versus 8.2% in the LARA ‐2 (n=5) ( P =ns). Univariate analysis only identified AF duration as a covariate associated with arrhythmia recurrence (hazard ratio, 1.01 [95% confidence interval, 1.002 to 1.012]; P <0.01). Conclusion The linear block at the LA roof is not associated with an improved clinical outcome compared with PV isolation alone. Clinical Trial Registration URL : ClinicalTrials.gov. Unique identifier: NCT 01203241.