Outcomes of long-standing persistent atrial fibrillation ablation: a systematic review.
BACKGROUND
Ablation of long-standing persistent atrial fibrillation (AF) is highly variable, with differing techniques and outcomes.


OBJECTIVE
The purpose of this study was to undertake a systematic review of the literature with regard to the impact of ablation technique on the outcomes of long-standing persistent AF ablation.


METHODS
A systematic search of the contemporary English scientific literature (from January 1, 1990 to June 1, 2009) in the PubMed database identified 32 studies on persistent/long-standing persistent or long-standing persistent AF ablation (including four randomized controlled trials). Data on single-procedure, drug-free success, multiple procedure success, and pharmaceutically assisted success at longest follow-up were collated.


RESULTS
Four studies performed pulmonary vein isolation alone (21%-22% success). Four studies performed pulmonary vein antrum ablation with isolation (PVAI; n = 2; 38%-40% success) or without confirmed isolation (PVA; n = 2; 37%-56% success). Ten studies performed linear ablation in addition to PVA (n = 5; 11%-74% success) or PVAI (n = 5; 38%-57% success). Three studies performed posterior wall box isolation (n = 3; 44%-50% success). Five studies performed complex fractionated atrial electrogram ablation (n = 5; 24%-63% success). Six studies performed complex fractionated atrial electrogram ablation as an adjunct to PVA (n = 2; 50%-51% success), PVAI (n = 3; 36%-61% success), or PVAI and linear (n = 1; 68% success) ablation. Five studies performed the stepwise ablation approach (38%-62% success).


CONCLUSIONS
The variation in success within and between techniques suggests that the optimal ablation technique for long-standing persistent AF is unclear. Nevertheless, long-standing persistent AF can be effectively treated with a composite of extensive index catheter ablation, repeat procedures, and/or pharmaceuticals.
Brooks
Anthony G
AG
Department of Cardiology, Royal Adelaide Hospital and the Disciplines of Medicine and Physiology, University of Adelaide, Cardiovascular Research Centre, Adelaide, Australia.
Stiles
Martin K
MK
Laborderie
Julien
J
Lau
Dennis H
DH
Kuklik
Pawel
P
Shipp
Nicholas J
NJ
Hsu
Li-Fern
LF
Sanders
Prashanthan
P
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D002908:Chronic Disease; D006801:Humans; D011667:Pulmonary Veins / Q000473:pathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents