title: Prognostic role of subsequent atrial tachycardias occurring during ablation of persistent atrial fibrillation: a prospective randomized trial.
abstract: BACKGROUND
  The role of subsequent atrial tachycardias (AT) in the context of persistent atrial fibrillation (AF) remains undetermined. This study evaluated the prognostic role of subsequent ATs for arrhythmia recurrences after catheter ablation of persistent AF.
  
  
  RESULTS
  A total of 110 patients with persistent AF (63±9 years; 22 women; 61 long-lasting persistent AF) underwent pulmonary vein isolation followed by electrogram-guided ablation. After AF terminated to AT, patients were separated by the randomization protocol to receive either direct cardioversion (group A) or further ablation of subsequent ATs to sinus rhythm (group B). After a mean follow-up of 20.1±13.3 months after the first procedure, significantly more group B patients were in sinus rhythm as compared with patients in group A (30 [57%] versus 18 [34%]; P=0.02). Moreover, recurrences of AF were significantly less frequent of group B than in group A patients (10 [19%] versus 26 [49%]; P=0.001). After the last procedure (follow-up, 34.0±6.4 months), significantly more group B patients were free of AF as compared with patients of group A (49 [92%] versus 39 [74%]; P=0.01). The proportion of AT recurrences did not differ between the 2 groups after the first and final procedures. The strongest predictor for an arrhythmia-free survival after a single procedure was randomization to the procedural end point of termination to sinus rhythm by elimination of subsequent ATs (P=0.004).
  
  
  CONCLUSIONS
  Catheter ablation of subsequent ATs increases freedom from AF but not AT, suggesting a contributing role of subsequent ATs in the mechanisms of persistent AF.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01896570.
authors.affiliation: II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
authors.forename: Tushar V
authors.initials: TV
authors.lastname: Salukhe
authors.forename: Boris A
authors.initials: BA
authors.lastname: Hoffmann
authors.forename: Daniel
authors.initials: D
authors.lastname: Steven
authors.forename: Imke
authors.initials: I
authors.lastname: Berner
authors.forename: Kai
authors.initials: K
authors.lastname: Müllerleile
authors.forename: Cathrin
authors.initials: C
authors.lastname: Theis
authors.forename: Karsten
authors.initials: K
authors.lastname: Bock
authors.forename: Helge
authors.initials: H
authors.lastname: Servatius
authors.forename: Arian
authors.initials: A
authors.lastname: Sultan
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation; D004554:Electric Countershock; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013612:Tachycardia, Ectopic Atrial / Q000150:complications*
keywords: arrhythmias cardiac; atrial fibrillation; catheter ablation; tachycardia, ectopic atrial