Optimalendpoint For Catheter Ablation Of Longstanding Persistent Atrial Fibrillation: A Randomized Clinical Trial

BackgroundIn 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.MethodsUtilized 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).ResultsA group with technical endpoint had lower rate of acute AF termination (AFsinus rhythm, 3.5%vs 18.1%; AFatrial tachycardia, 23.7%vs 44.7%; P<0.01) and shorter duration of ablation (164.9 20.8vs 223.4 +/- 24.9, P<0.01), radiofrequency delivery time (69.8 +/- 18.1vs 102.2 +/- 26.3, P<0.01), and x-ray exposure time (18.2 +/- 8.8vs 27.9 +/- 12.4, P<0.01) than those in B group (pursuing AF termination). During follow-up, freedom from atrial arrhythmias didnotdifferbetweenthetwo 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).ConclusionIn 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.