Does termination predict the outcome at long term follow-up in patients with long standing persistent AF? results from a prospective randomized study

Abstract

Introduction: In patients (pts) with long standing persistent (LSP) atrial fibrillation (AF) in addition to pulmonary vein isolation (PVI), extensive substrate ablation (abl) is important to achieve long term success. Whether AF termination (term) during abl should be considered an endpoint is controversial. After PV and posterior wall (PW) isolation was completed in all pts, we investigated if AF term with or without additional abl could influence the outcome. Methods: This prospective study included 302 consecutive pts with LSP AF undergoing abl for AF and experiencing AF term during abl (defined as conversion to sinus rhythm). After AF term, pts were randomized to verification of PVs and PW isolation plus consolidation of lesions at the site of term (group 1), versus additional abl of non PV trigger before and after challenge with isoproterenol (group 2). Follow‐up was performed in all pts at 3‐6 and 12 months and every 6 months thereafter. Results: Group 1 consisted of 158 pts, (62±11 y, 76% male, LVEF 55±11, LA size 4.62±0.6 cm) while Group 2 consisted of 144 pts (63±10 y, 74% male, LVEF 56±10, LA size 4.68±0.7 cm). At 31±7 months, 48 (31%) in group 1 and 96 (67%) in group 2 were arrhythmia‐free off‐AAD (log‐rank p