title: Importance of sinus rhythm as endpoint of persistent atrial fibrillation ablation.
abstract: BACKGROUND
  The endpoint of persistent atrial fibrillation (AF) ablation is still a matter of debate. The purpose of this study was to evaluate if sinus rhythm (SR) as endpoint of persistent AF ablation has a better long-term outcome compared to atrial tachycardia (AT) or AF at the end of the procedure.
  
  
  RESULTS
  Between 2008 and 2011, 191 consecutive patients undergoing de novo catheter ablation for symptomatic persistent and long-standing persistent AF using a sequential ablation approach (including pulmonary vein isolation, ablation of complex fractionated electrograms and linear lesions) were included in the study. According to the result at the end of ablation procedure, patients were classified into 3 groups: patients with termination of AF into SR (Group 1, n = 62), patients with AT undergoing cardioversion (CV) (Group 2, n = 47), or patients with AF undergoing CV (Group 3, n = 82). The primary endpoint was freedom from any atrial tachyarrhythmia off antiarrhythmic drugs at 12 months. At 12 months, estimated proportions of patients free from any arrhythmia recurrence were 42% for Group 1, 13% for Group 2, and 25% for Group 3 (P = 0.002). In a Cox regression analysis only termination into SR was associated with a lower risk of arrhythmia recurrence (HR: 0.62; P = 0.04).
  
  
  CONCLUSIONS
  If SR is achieved as endpoint of persistent and long-standing persistent AF ablation using a sequential ablation approach it is associated with the highest long-term single procedure success rate compared to AT or AF at the end of the procedure.
authors.affiliation: German Heart Center Munich, Munich, Germany. ammar@dhm.mhn.de
authors.forename: Sonia
authors.initials: S
authors.lastname: Ammar
authors.forename: Gabriele
authors.initials: G
authors.lastname: Hessling
authors.forename: Tilko
authors.initials: T
authors.lastname: Reents
authors.forename: Maria
authors.initials: M
authors.lastname: Paulik
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fichtner
authors.forename: Patrick
authors.initials: P
authors.lastname: Schön
authors.forename: Roger
authors.initials: R
authors.lastname: Dillier
authors.forename: Susanne
authors.initials: S
authors.lastname: Kathan
authors.forename: Clemens
authors.initials: C
authors.lastname: Jilek
authors.forename: Christof
authors.initials: C
authors.lastname: Kolb
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haller
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
mesh_terms: D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004554:Electric Countershock; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents