title: Complex fractionated atrial electrogram or linear ablation in patients with persistent atrial fibrillation--a prospective randomized study.
abstract: BACKGROUND
  Catheter ablation of complex fractionated atrial electrograms (CFAE) for persistent atrial fibrillation (AF) is a promising treatment strategy. We tested the hypothesis that CFAE ablation is superior to linear ablation in patients with persistent or long-standing persistent AF.
  
  
  METHODS
  In this study, 116 patients with persistent AF were randomly assigned to undergo circumferential PVI plus additional lines (linear ablation group; 59 patients) or CFAE ablation plus ostial pulmonary vein isolation (PVI) (spot ablation group; 57 patients). Primary endpoint was freedom from atrial tachyarrhythmia after a single ablation procedure (clinical and repeat 7-day Holter), 12 months after ablation without antiarrhythmic medication.
  
  
  RESULTS
  The primary endpoint was reached in 22 of 59 (37%) patients of the linear ablation group and in 22 of 57 (39%) patients of the spot ablation group (P = 0.9). Freedom from atrial tachyarrhythmias, including reablations, was achieved in 54% of patients (linear ablation group) versus 56% of patients (spot ablation group; P = 0.8). The incidence of recurrent persistent AF was higher after linear ablation than after spot ablation (21/37 vs 11/35 patients; P = 0.03); atrial tachycardia (AT) was seen more often after spot ablation (10/35 vs 4/37 patients; P = 0.03).
  
  
  CONCLUSIONS
  In patients with persistent AF, CFAE ablation plus PVI reaches the same results as circumferential PVI plus lines, in terms of freedom from symptomatic atrial tachyarrhythmias within the first year after a single ablation procedure. Arrhythmia recurrences in patients after spot ablation were caused more often by AT, whereas recurrent persistent AF was more prevalent after the linear ablation approach.
authors.affiliation: Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. estner@dhm.mhn.de
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Estner
authors.forename: Gabriele
authors.initials: G
authors.lastname: Hessling
authors.forename: Roman
authors.initials: R
authors.lastname: Biegler
authors.forename: Juergen
authors.initials: J
authors.lastname: Schreieck
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fichtner
authors.forename: Jinjin
authors.initials: J
authors.lastname: Wu
authors.forename: Clemens
authors.initials: C
authors.lastname: Jilek
authors.forename: Bernhard
authors.initials: B
authors.lastname: Zrenner
authors.forename: Gjin
authors.initials: G
authors.lastname: Ndrepepa
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome