title: Does the amount of atrial mass reduction improve clinical outcomes after radiofrequency catheter ablation for long-standing persistent atrial fibrillation? Comparison between linear ablation and defragmentation.
abstract: BACKGROUND
  Although a large isolated surface area of the left atrium (LA) may improve the success rate of catheter ablation (CA) for paroxysmal atrial fibrillation (AF), little is known about the relation between clinical outcomes and the amount of atrial mass reduction (AMR: ratio of total isolated and ablated areas to LA surface area) in different ablation strategies for patients with long-standing persistent AF (L-PeAF).
  
  
  METHODS
  We randomly assigned 119 consecutive L-PeAF patients to adjunctive linear ablation (n=60) or complex fractionated atrial electrogram (CFAE)-guided ablation (n=59) after circumferential antral pulmonary vein isolation (PVI). Linear lesions included roof and anterior lines with conduction block. LA defragmentation was performed with an automated CFAE-detection algorithm. Cavotricuspid isthmus block was performed in all patients. Creatine kinase-MB (CK-MB) and troponin-T levels were measured 1 day post-CA.
  
  
  RESULTS
  CK-MB and troponin-T levels were higher, ablation time was longer, and AMR was greater in the CFAE-guided ablation group than in the linear ablation group. AF termination during CA was more frequently observed in the linear ablation group than in the CFAE-guided ablation group (P=0.031). Twelve months after a single procedure, recurrence occurred in 16 (26.7%) patients with linear ablation and 27 (45.8%) patients with CFAE-guided ablation (P=0.023). On multivariate analysis, LA volume and ablation method were the only independent risk factors for arrhythmia recurrence.
  
  
  CONCLUSIONS
  Conduction block through linear lines+PVI was an efficient ablation strategy for L-PeAF, whereas the AMR amount did not influence clinical outcomes.
authors: Department of Cardiology, Hallym University Hangang Sacred Heart Hospital, 94-200 Yeongdeungpo-dong 2-ga, Yeongdeungpo-gu, Seoul, Republic of Korea.
authors: Seong Woo
authors: SW
authors: Han
authors: Division of Cardiology, Heart Research Institute, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong, Dongjak-gu, Seoul, Republic of Korea.
authors: Seung Yong
authors: SY
authors: Shin
authors: Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
authors: Sung Il
authors: SI
authors: Im
authors: Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
authors: Jin Oh
authors: JO
authors: Na
authors: Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
authors: Cheol Ung
authors: CU
authors: Choi
authors: Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
authors: Seong Hwan
authors: SH
authors: Kim
authors: Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
authors: Jin Won
authors: JW
authors: Kim
authors: Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
authors: Eung Ju
authors: EJ
authors: Kim
authors: Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
authors: Seung-Woon
authors: SW
authors: Rha
authors: Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
authors: Chang Gyu
authors: CG
authors: Park
authors: Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
authors: Hong Seog
authors: HS
authors: Seo
authors: Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
authors: Dong Joo
authors: DJ
authors: Oh
authors: Division of Cardiology, Utah Valley Regional Medical Center, 1055 North 500 West, Provo, UT 84604, USA.
authors: Chun
authors: C
authors: Hwang
authors: Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea. Electronic address: hongeuy@korea.ac.kr.
authors: Hong Euy
authors: HE
authors: Lim
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods* / Q000639:trends*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Atrial fibrillation; Atrial mass; Complex fractionated atrial electrograms; Linear ablation