title: Evaluation of linear lesions in the left and right atrium in ablation of long-standing atrial fibrillation.
abstract: BACKGROUND
  This randomized prospective study compared three ablation strategies in patients with long-standing persistent atrial fibrillation (LPeAF). It also explored the best procedural endpoint from among the following: circumferential pulmonary vein isolation (PVI) + left atrial (LA) linear lesions (roofline, mitral isthmus) + complex fractionated atrial electrogram (CFAE) ablation, PVI + LA linear lesions + cavotricuspid isthmus (CTI) ablation + CFAE ablation, and PVI + CFAE ablation.
  
  
  RESULTS
  A total of 210 patients with LPeAF referred for catheter ablation were enrolled and randomized into three ablation groups. The patients in group A (n = 70) underwent PVI followed by LA linear and CFAE ablation; in 93% of patients the primary endpoint was achieved (five patients with incomplete linear lesions). Of the 70 patients in group B who were subjected to PVI followed by LA linear, CFAE, and CTI ablations, in 94% of patients the primary endpoint was achieved (four patients with incomplete linear lesions). All patients in group C (n = 70) successfully underwent PVI and CFAE ablation. Direct current cardioversion was performed upon PVI, CFAE elimination, and completion of linear lesions. Patients were followed-up for atrial tachyarrhythmia recurrence for at least 24 months. After a single ablation procedure, group C (36%) exhibited the lowest success compared with group A (54%) and group B (51%) (P = 0.06). At the mean follow-up of 32 ± 9 months after the final ablation procedure, 53 patients (76%) in group A, 53 (76%) in group B, and 41 (59%) in group C were in sinus rhythm without antiarrhythmic drugs (P = 0.03).
  
  
  CONCLUSIONS
  In LPeAF, linear lesions in the LA help improve outcome of ablation, additional CTI ablation does not.
authors.affiliation: Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China.
authors.forename: Yuan-Long
authors.initials: YL
authors.lastname: Wang
authors.forename: Xu
authors.initials: X
authors.lastname: Liu
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Tan
authors.forename: Li
authors.initials: L
authors.lastname: Zhou
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Jiang
authors.forename: Jun
authors.initials: J
authors.lastname: Gu
authors.forename: Yu-Gang
authors.initials: YG
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods* / Q000706:statistics & numerical data*; D002681:China / Q000453:epidemiology; D002908:Chronic Disease; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: ablation; atrial fibrillation; complex fractionated atrial electrogram; linear lesions; pulmonary vein isolation