title: Persistent Atrial Fibrillation Ablation using the Tip-Versatile Ablation Catheter.
abstract: BACKGROUND
  The mechanisms by which persistent atrial fibrillation (PsAF) develops are incompletely understood. Consequently, the optimal strategy for the ablative management of PsAF remains debated. Current methods are often time consuming, complex and non-reproducible. We assessed the Tip-Versatile Ablation Catheter (T-VAC) technique, a rapidly delivered, empirical technique based on the box-set concept using duty-cycled linear catheter ablation technology.
  
  
  METHODS
  Forty-four procedures in 40 patients undergoing PsAF ablation with the novel technique were prospectively entered onto a database: 27 de novo. Primary endpoint was freedom from arrhythmia at over two-year follow-up. Secondary endpoints were time to first arrhythmia recurrence, freedom from atrial fibrillation (AF) on and off antiarrhythmic drugs (AAD), procedural and fluoroscopy duration and complication rate.
  
  
  RESULTS
  At mean follow-up of 33 months, absolute freedom from arrhythmia recurrence was 45% in the de novo group. Overall, at 33 (IQR 24-63) months, 60% of de novo patients were in sustained normal sinus rhythm and a further 15% reported only occasional paroxysms of AF at long-term follow-up. Procedure time was 192±25 mins, total energy delivered 2239±883s and fluoroscopy time was 60±10mins.
  
  
  CONCLUSIONS
  In selected patients with persistent AF, a long-term rate of 60% arrhythmia free survival off AAD can be achieved using this novel T-VAC technique.
authors.affiliation: South West Cardiothoracic Centre, Plymouth, UK. Electronic address: dreddavies@gmail.com.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Davies
authors.affiliation: South West Cardiothoracic Centre, Plymouth, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Clayton
authors.affiliation: South West Cardiothoracic Centre, Plymouth, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Lines
authors.affiliation: South West Cardiothoracic Centre, Plymouth, UK.
authors.forename: Guy A
authors.initials: GA
authors.lastname: Haywood
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Ablation; Atrial fibrillation; Catheter ablation; Duty-cycled; Persistent atrial fibrillation