title: Does linear ablation and defragmentation really improve the success rate of persistent AF? Follow-up results and electrophysiological findings from 169 consecutive patients.
abstract: BACKGROUND
  Catheter ablation of persistent atrial fibrillation (AF) has been performed with varying results using a combination of different techniques. We sought to evaluate the efficacy of additional linear lesion and defragmentation of left atrium (LA).
  
  
  METHODS
  A cohort of 169 patients with persistent AF was studied. Ablation was performed following a sequential strategy consisted of circumferential pulmonary vein isolation (CPVI), LA roof linear ablation, posterior mitral area, coronary sinus and cavotricuspid isthmus, and complex fractionated electrograms ablation.
  
  
  RESULTS
  During a mean follow-up of 15 ± 8 months after a single procedure, 84 (50%) patients were in sinus rhythm, 34 (20%) had an AF recurrence and 51(30%) developed atrial tachycardias (ATs). Repeat procedures were performed in 24 recurrent AF and 46 AT patients. A total of 81 different ATs were mapped and ablated in 46 AT patients, characterized as focal for 45 and macroreentry for 36 ATs. Most of the ATs were likely to be attributed to the previous lesions by an analysis of substrate and activation mapping in the redo procedure and a review of the lesions placed in the initial procedure. Overall, 75 (93%) ATs were ablated successfully. Procedural complications occurred in 11 of the 239 procedures. After a mean follow-up of 20 ± 9 months, 128 (76%) patients were free of arrhythmias after the final procedure.
  
  
  CONCLUSIONS
  CPVI supplemented by linear ablation and defragmentation does not seem to improve the overall success rate of persistent AF. The efficacy of linear ablation and defragmentation might be diluted by their proarrhythmic effects.
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Yazhou
authors.initials: Y
authors.lastname: Lin
authors.forename: Weizhu
authors.initials: W
authors.lastname: Ju
authors.forename: Bing
authors.initials: B
authors.lastname: Yang
authors.forename: Hongwu
authors.initials: H
authors.lastname: Chen
authors.forename: Fengxiang
authors.initials: F
authors.lastname: Zhang
authors.forename: Mingfang
authors.initials: M
authors.lastname: Li
authors.forename: Jinbo
authors.initials: J
authors.lastname: Yu
authors.forename: Kejiang
authors.initials: K
authors.lastname: Cao
authors.forename: Minglong
authors.initials: M
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: Atrial fibrillation; Atrial tachycardia; Catheter ablation