Does linear ablation and defragmentation really improve the success rate of persistent AF? Follow-up results and electrophysiological findings from 169 consecutive patients

Abstract

BackgroundCatheter ablation of persistent atrial fibrillation (AF) has been performed with varying results using a combination of different techniques. We sought to evaluate the efficacy of additional linear lesion and defragmentation of left atrium (LA). MethodsA cohort of 169 patients with persistent AF was studied. Ablation was performed following a sequential strategy consisted of circumferential pulmonary vein isolation (CPVI), LA roof linear ablation, posterior mitral area, coronary sinus and cavotricuspid isthmus, and complex fractionated electrograms ablation. ResultsDuring a mean follow-up of 15±8months after a single procedure, 84 (50%) patients were in sinus rhythm, 34 (20%) had an AF recurrence and 51(30%) developed atrial tachycardias (ATs). Repeat procedures were performed in 24 recurrent AF and 46 AT patients. A total of 81 different ATs were mapped and ablated in 46 AT patients, characterized as focal for 45 and macroreentry for 36 ATs. Most of the ATs were likely to be attributed to the previous lesions by an analysis of substrate and activation mapping in the redo procedure and a review of the lesions placed in the initial procedure. Overall, 75 (93%) ATs were ablated successfully. Procedural complications occurred in 11 of the 239 procedures. After a mean follow-up of 20±9months, 128 (76%) patients were free of arrhythmias after the final procedure. ConclusionsCPVI supplemented by linear ablation and defragmentation does not seem to improve the overall success rate of persistent AF. The efficacy of linear ablation and defragmentation might be diluted by their proarrhythmic effects.