title: Is pursuit of termination of atrial fibrillation during catheter ablation of great value in patients with longstanding persistent atrial fibrillation?
abstract: BACKGROUND
  The reliable endpoint for ablation of longstanding persistent atrial fibrillation (LPAF) has not been clearly established.
  
  
  RESULTS
  This study included 140 patients who underwent catheter ablation for drug-refractory LPAF. A stepwise ablation approach included circumferential pulmonary vein isolation followed by left atrial and right atrial complex fractionated electrogram-guided ablation. Atrial fibrillation (AF) was terminated by radiofrequency application during catheter ablation in 95 patients (67.9%). Among them, 33 patients (23.6%) converted to sinus rhythm directly, whereas 62 patients (44.3%) via atrial tachycardias (ATs). Patients in whom AF terminated during the index procedure had a lower recurrence rate of atrial arrhythmia than patients in whom AF did not terminate (45.3% vs 68.9%, P = 0.009, follow-up 18.7 ± 7.6 months). Among patients in whom AF terminated, there was no significant difference in recurrence rate according to the termination mode, whether converted to AT or not (P = NS). However, patients who converted to AT had a higher recurrence rate of AT (54.8% vs 81%; P = 0.016). Multivariable logistic regression analysis demonstrated that termination of AF during ablation (HR 0.440; 95% CI: 0.200-0.969, P = 0.041) and structural heart disease (HR 2.633; 95% CI: 1.211-5.723; P = 0.015) were significant independent factors predicting the recurrence of atrial arrhythmia.
  
  
  CONCLUSIONS
  Termination of AF during catheter ablation is associated with a better clinical outcome in patients with LPAF.
authors.affiliation: Division of Cardiology, Korea University, Seoul, South Korea.
authors.forename: Yae M
authors.initials: YM
authors.lastname: Park
authors.forename: Jong-Il
authors.initials: JI
authors.lastname: Choi
authors.forename: Hong E
authors.initials: HE
authors.lastname: Lim
authors.forename: Sang W
authors.initials: SW
authors.lastname: Park
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D018572:Disease-Free Survival; D004351:Drug Resistance; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents