title: Randomized ablation strategies for the treatment of persistent atrial fibrillation: RASTA study.
abstract: BACKGROUND
  The single-procedure efficacy of pulmonary vein isolation (PVI) is less than optimal in patients with persistent atrial fibrillation (AF). Adjunctive techniques have been developed to enhance single-procedure efficacy in these patients. We conducted a study to compare 3 ablation strategies in patients with persistent AF.
  
  
  RESULTS
  Subjects were randomized as follows: arm 1, PVI + ablation of non-PV triggers identified using a stimulation protocol (standard approach); arm 2, standard approach + empirical ablation at common non-PV AF trigger sites (mitral annulus, fossa ovalis, eustachian ridge, crista terminalis, and superior vena cava); or arm 3, standard approach + ablation of left atrial complex fractionated electrogram sites. Patients were seen at 6 weeks, 6 months, and 1 year; transtelephonic monitoring was performed at each visit. Antiarrhythmic drugs were discontinued at 3 to 6 months. The primary study end point was freedom from atrial arrhythmias off antiarrhythmic drugs at 1 year after a single-ablation procedure. A total of 156 patients (aged 59±9 years; 136 males; AF duration, 47±50 months) participated (arm 1, 55 patients; arm 2, 50 patients; arm 3, 51 patients). Procedural outcomes (procedure, fluoroscopy, and PVI times) were comparable between the 3 arms. More lesions were required to target non-PV trigger sites than a complex fractionated electrogram (33±9 versus 22±9; P<0.001). The primary end point was achieved in 71 patients and was worse in arm 3 (29%) compared with arm 1 (49%; P=0.04) and arm 2 (58%; P=0.004).
  
  
  CONCLUSIONS
  These data suggest that additional substrate modification beyond PVI does not improve single-procedure efficacy in patients with persistent AF.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00379301.
authors.affiliation: Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. sanjay.dixit@uphs.upenn.edu
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.forename: Rupa
authors.initials: R
authors.lastname: Bala
authors.forename: Michael P
authors.initials: MP
authors.lastname: Riley
authors.forename: Fermin C
authors.initials: FC
authors.lastname: Garcia
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Hutchinson
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Ratcliffe
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Cooper
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Verdino
authors.forename: Vickas V
authors.initials: VV
authors.lastname: Patel
authors.forename: Erica S
authors.initials: ES
authors.lastname: Zado
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Cash
authors.forename: Tony
authors.initials: T
authors.lastname: Killian
authors.forename: Todd T
authors.initials: TT
authors.lastname: Tomson
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome