title: Pulmonary Vein Isolation Versus Defragmentation: The CHASE-AF Clinical Trial.
abstract: BACKGROUND
  Long-term success rates using ablation for persistent atrial fibrillation (AF) are disappointing and usually do not exceed 60%.
  
  
  OBJECTIVE
  This study sought to compare arrhythmia-free survival between pulmonary vein isolation (PVI) and a stepwise approach (full defrag) consisting of PVI, ablation of complex fractionated electrograms, and additional linear ablation lines in the setting of atrial tachycardias (AT) in patients with persistent AF after PVI.
  
  
  METHODS
  From November 2010 to February 2013, 205 patients (151 men; 61.7 ± 10.2 years of age) underwent de novo ablation for persistent AF. Subsequently, patients were prospectively randomized to either PVI alone (n = 78) or full defrag (n = 75), with 52 patients not randomized due to AF termination with the original PVI. The primary endpoint was recurrence of any AT after a blanking period of 3 months.
  
  
  RESULTS
  During the entire study, 241 ablations were performed (mean: 1.59 in the PVI-alone group, 1.55 in the full-defrag group). With the stepwise approach, termination of AF occurred in 45 (60%) patients. However, arrhythmia-free survival did not differ whether patients underwent single or multiple procedures (p = 0.468). Procedure duration, fluoroscopy time, and radiofrequency duration were significantly longer in the full-defrag group (all p < 0.001).
  
  
  CONCLUSIONS
  A stepwise approach aimed at AF termination does not seem to provide additional benefit over PVI alone in patients with persistent AF, but it is associated with significantly longer procedural and fluoroscopic duration as well as radiofrequency application time. (The Randomized Catheter Ablation of Persist End Atrial Fibrillation Study [CHASE-AF]; NCT01580124).
authors.affiliation: Department of Electrophysiology, University Heart Center Hamburg, University Hospital Eppendorf, Hamburg, Germany. Electronic address: j.vogler@uke.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Vogler
authors.affiliation: Department of Electrophysiology, University Heart Center Hamburg, University Hospital Eppendorf, Hamburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
authors.affiliation: Department of Electrophysiology, University Heart Center Cologne, University Hospital Cologne, Cologne, Germany.
authors.forename: Arian
authors.initials: A
authors.lastname: Sultan
authors.affiliation: Department of Electrophysiology, Clinic Hirslanden-Heart Center, Zurich, Switzerland.
authors.forename: Doreen
authors.initials: D
authors.lastname: Schreiber
authors.affiliation: Department of Electrophysiology, University Heart Center Cologne, University Hospital Cologne, Cologne, Germany.
authors.forename: Jakob
authors.initials: J
authors.lastname: Lüker
authors.affiliation: Department of Cardiology Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Helge
authors.initials: H
authors.lastname: Servatius
authors.affiliation: Department of Electrophysiology, University Heart Center Hamburg, University Hospital Eppendorf, Hamburg, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schäffer
authors.affiliation: Department of Electrophysiology, University Heart Center Hamburg, University Hospital Eppendorf, Hamburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Moser
authors.affiliation: Department of Electrophysiology, University Heart Center Hamburg, University Hospital Eppendorf, Hamburg, Germany.
authors.forename: Boris A
authors.initials: BA
authors.lastname: Hoffmann
authors.affiliation: Department of Electrophysiology, University Heart Center Cologne, University Hospital Cologne, Cologne, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Steven
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: atrial tachycardia; complex fractionated atrial electrogram; paroxysmal; stepwise