P887Pulmonary vein isolation vs. additional linear ablation for patients with persistent atrial fibrillation those changed to paroxysmal type with antiarrhythmic therapy: a multi-center randomized study

Abstract

Background: Type of atrial fibrillation (AF) can change depending on the condition and time, and some of patients with initially presented persistent AF (PeAF) changed to paroxysmal AF (PAF) after anti‐arrhythmic drug (AAD) medication and/or cardioversion. Purpose: We sought to evaluate if addition of linear lesions and an achievement of a complete bidirectional block of linear lesions improves clinical outcome in patients with PeAF to PAF. Methods: The study population included 113 patients with PeAF to PAF (male 75.2%, 60.4±10.1 years old) who underwent RFCA for symptomatic and drug‐refractory non‐valvular AF at 3 tertiary hospitals in Korea. The participants were randomly assigned to either CPVI alone group (n=59) or the CPVI plus linear ablation (Line) group (Dallas lesion set; posterior box+anterior line, n=54). The primary outcome was freedom from clinical recurrence of AF after RFCA. Results: 1. Compare to CPVI+Line group, CPVI alone required shorter procedure (187.2±58.0min vs. 211.2±63.9min, P=0.043) and ablation times (4922.1±1110.5sec vs. 6205.7±1425.2sec, P<0.001) without significant difference in procedure related major complication rate (3.4%, vs. 1.9%, P=0.611). 2. During the 18.6±11.4 months of follow‐up, the clinical recurrence rates were not significantly different between CPVI alone group and CPVI+Line group (P=0.171). 3. AAD utility rates after RFCA were not significantly different between two groups (22.0% vs. 29.6%, P=0.356). 4. Overall AF‐free survival rate (log‐rank, P=0.206) and AF and AAD‐free survival rate (log‐rank, P=0.321) were not significantly different between two groups. 5. In CPVI+Line group, patients who achieved a complete bidirectional block with the Dallas lesion set showed an improved clinical outcome of AF ablation compared to those with an incomplete bidirectional block (log‐rank, P=0.025). Conclusion: CPVI alone is an effective rhythm control strategy with shorter procedure time for PeAF who were converted as PAF with AADs after external electrical cardioversion, compared to CPVI with additional linear ablation. Achievement of a complete bidirectional block with the Dallas lesion set improved clinical outcome of AF ablation.