Approaches to Catheter Ablation for
Persistent Atrial Fibrillation
APPROACHES
Ablation with pulmonary-vein isolation alone
Pulmonary-vein isolation plus ablation of complex fractionated electrograms
Pulmonary-vein isoation plus linear ablation
CRITERIA
INCLUSION
Older than 18 yars old
They should have symptomatic persistent atrial fibrilation
They have to be undergoing ablation for the first time
All participating patients provided written informed consent
EXCLUSION
Paroxysmal atrial fibrilation
Sustained atrial fibrilation lasting more than 3 years
Left atrial diameter of 60mm or greater
PATIENTS WERE RANDOMLY ASSIGNED
IN THIS WAY
Pulmonary-vein isolation alone
Pulmonary-vein isolation plus ablation of compex fractionated electrograms
Pulmonary-vein isolation plus linear ablation across the roof of the left atrium and in the mitrial valve ithmus
POCEDURES
It was used radio diofrequency energy delivered by a catheter with an open, irrigated tip
Antigulation was continued after ablation for a minimum of 3 months
Before ablation, tratment with antiarrhythmic medications was stopped and patients recived oral anticoagulation for at least 4 weeks
CLINICAL ASSESTENTS
EKG 12 lead
Holter-monitor
Trans-telephonic monitor
STUDY OUTCOMES
freedom from any documented episode of atrial fibrillation lasting longer than 30 seconds and
occurring after the performance of a single ablation procedure
Main secondary outcomes included freedom from documented atrial fibrillation after two ablation
procedures
The expected freedom from atrial fibrillation after one ablation procedure was 75% for isolation
plus electrograms and 45% for isolation alone.
Successful pulmonary-vein isolation was achieved in 97% of all patients, with no significant
differences between groups.
Adverse Events
The most common adverse events were sedation-related complications
Arteriovenous fistula or pseudoaneurysm at the access site