title: Clinical outcome of ablation for long-standing persistent atrial fibrillation with or without defragmentation.
abstract: OBJECTIVE
  To assess the outcome and associated risks of atrial defragmentation for the treatment of long-standing persistent atrial fibrillation (LSP-AF).
  
  
  METHODS
  Thirty-seven consecutive patients (60.4 ± 7.3 years; 28 male) suffering from LSP-AF who underwent pulmonary vein isolation (PVI) and linear ablation were compared. All patients were treated with the Stereotaxis magnetic navigation system (MNS). Two groups were distinguished: patients with (n = 20) and without (n = 17) defragmentation. The primary endpoint of the study was freedom of AF after 12 months. Secondary endpoints were AF termination, procedure time, fluoroscopy time and procedural complications. Complications were divided into two groups: major (infarction, stroke, major bleeding and tamponade) and minor (fever, pericarditis and inguinal haematoma).
  
  
  RESULTS
  No difference was seen in freedom of AF between the defragmentation and the non-defragmentation group (56.2 % vs. 40.0 %, P = 0.344). Procedure times in the defragmentation group were longer; no differences in fluoroscopy times were observed. No major complications occurred. A higher number of minor complications occurred in the defragmentation group (45.0 % vs. 5.9 %, P = 0.009). Mean hospital stay was comparable (4.7 ± 2.2 vs. 3.4 ± 0.8 days, P = 0.06).
  
  
  CONCLUSIONS
  Our study suggests that complete defragmentation using MNS is associated with a higher number of minor complications and longer procedure times and thus compromises efficiency without improving efficacy.
authors.affiliation: Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: L J
authors.initials: LJ
authors.lastname: de Vries
authors.forename: F
authors.initials: F
authors.lastname: Akca
authors.forename: M
authors.initials: M
authors.lastname: Khan
authors.forename: L
authors.initials: L
authors.lastname: Dabiri-Abkenari
authors.forename: P
authors.initials: P
authors.lastname: Janse
authors.forename: D A M J
authors.initials: DA
authors.lastname: Theuns
authors.forename: E
authors.initials: E
authors.lastname: Peters
authors.forename: G
authors.initials: G
authors.lastname: de Ruiter
authors.forename: T
authors.initials: T
authors.lastname: Szili-Torok