title: Improved outcome following restoration of sinus rhythm prior to catheter ablation of persistent atrial fibrillation: a comparative multicenter study.
abstract: BACKGROUND
  Catheter ablation of persistent atrial fibrillation (AF) is associated with longer procedure times and lower long-term success rates than that of paroxysmal AF.
  
  
  OBJECTIVE
  To test the hypothesis that restoration/maintenance of sinus rhythm (SR) preablation would facilitate AF termination and improve outcomes in patients with persistent AF.
  
  
  METHODS
  We conducted a 2-group cohort study of consecutive patients with persistent AF and SR restored for at least 1 month prior to ablation (SR group; n = 40) and controls matched by age, sex, and AF duration (control group; n = 40). Radiofrequency stepwise catheter ablation was performed in AF for both groups (induced and spontaneous, respectively). Success was defined as freedom from atrial tachyarrhythmia without antiarrhythmic drugs beyond 1 year of follow-up.
  
  
  RESULTS
  During the index ablation procedure, AF cycle length was longer in the SR group than in the control group (183 ± 32 ms vs 166 ± 20 ms; P = .06), suggestive of reverse remodeling. In the SR group, AF more frequently terminated during ablation (95.0% vs 77.5%; P <.05) and required less extensive ablation of complex fractionated electrograms (40.0% vs 87.5%; P <.001) and linear lesions (42.5% vs 82.5%; P <.001). Mean procedural (199.8 ± 69.8 minutes vs 283.5 ± 72.3 minutes; P <.001), fluoroscopy (51.0 ± 24.9 minutes vs 96.3 ± 32.1 minutes; P <.001), and radiofrequency energy delivery (47.5 ± 18.9 minutes vs 97.0 ± 30.6 minutes; P <.001) times were shorter in the SR group. Clinical success rates were similar between groups for first (55.0% vs 45.0%; P = .28) and last (80.0% vs 70.0%; P = .28) procedures, during similar follow-up periods (21.1 ± 9.7 months).
  
  
  CONCLUSIONS
  Restoration of SR prior to catheter ablation for persistent AF whenever possible decreases the extent of ablation with the same high clinical efficacy.
authors.affiliation: Hôpital Cardiologique du Haut Lévêque, Bordeaux-Pessac, France. lena.rivard@umontreal.ca
authors.forename: Léna
authors.initials: L
authors.lastname: Rivard
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
authors.forename: Bruno
authors.initials: B
authors.lastname: Cauchemez
authors.forename: Andrei
authors.initials: A
authors.lastname: Forclaz
authors.forename: Amir S
authors.initials: AS
authors.lastname: Jadidi
authors.forename: Nick
authors.initials: N
authors.lastname: Linton
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nault
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Xingpeng
authors.initials: X
authors.lastname: Liu
authors.forename: Olivier
authors.initials: O
authors.lastname: Xhaet
authors.forename: Ashok
authors.initials: A
authors.lastname: Shah
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sacher
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
authors.forename: Stanley
authors.initials: S
authors.lastname: Nattel
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome