Approaches to catheter ablation for persistent atrial fibrillation

A. Verma, C. Jiang, T.R. Betts, J. Chen, I. Deisenhofer, R. Mantovan, L. Macle, C.A. Morillo, W. Haverkamp, Hemal Weerasooriya, J.P. Albenque, S. Nardi, E. Menardi, P. Novak, P. Sanders

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    Abstract

    BACKGROUND: Catheter ablation is less successful for persistent atrial fibrillation than for paroxysmal atrial fibrillation. Guidelines suggest that adjuvant substrate modification in addition to pulmonary-vein isolation is required in persistent atrial fibrillation. METHODS: We randomly assigned 589 patients with persistent atrial fibrillation in a 1:4:4 ratio to ablation with pulmonary-vein isolation alone (67 patients), pulmonary-vein isolation plus ablation of electrograms showing complex fractionated activity (263 patients), or pulmonary-vein isolation plus additional linear ablation across the left atrial roof and mitral valve isthmus (259 patients). The duration of follow-up was 18 months. The primary end point was freedom from any documented recurrence of atrial fibrillation lasting longer than 30 seconds after a single ablation procedure. RESULTS: Procedure time was significantly shorter for pulmonary-vein isolation alone than for the other two procedures (P
    Original languageEnglish
    Pages (from-to)1812-1822
    JournalThe New England Journal of Medicine
    Volume372
    Issue number19
    DOIs
    Publication statusPublished - 2015

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