Ablation of Complex Fractionated Electrograms With or Without ADditional LINEar Lesions for Persistent Atrial Fibrillation (The ADLINE Trial).
BACKGROUND
For persistent atrial fibrillation (AF) ablation, different strategies including complex fractionated atrial electrograms (CFAE) ablation and linear lesions (LL) have been used in addition to pulmonary vein isolation (PVI). However, it is still a matter of debate if extended substrate modification improves long-term outcome. The aim of this study was to determine the benefit of LL in addition to PVI and CFAE ablation regarding freedom from arrhythmia recurrence in patients with persistent AF.


METHODS
The study was a prospective randomized trial including 90 patients with persistent and longstanding persistent AF. All patients underwent PVI and CFAE ablation. If AF did not terminate to atrial tachycardia (AT) or sinus rhythm, patients were randomized to direct current cardioversion (Group 1; n = 45) or LL (Group 2; n = 45). Primary endpoint was freedom from any atrial arrhythmia off antiarrhythmic drugs at 12 months. (NCT02059369) RESULTS: Baseline characteristics were similar between the two groups with more than half of the patients having structural heart disease. The primary endpoint was reached in 37% in Group 1 (G1) and 16% in Group 2 (G2; P = 0.03). After a total number of 1.4 ± 0.5 (G1) versus 1.7 ± 0.4 (G2; P = 0.01) procedures, freedom from any arrhythmia was reached in 54% in G1 and 65% in G2 (P = 0.35).


CONCLUSIONS
In persistent AF ablation, LL in addition to PVI and CFAE show a significantly lower success rate after a single procedure compared to PVI and CFAE. Following LL, significantly more patients needed a reablation to reach a similar success rate during a 12-month follow-up.
Klinikum Coburg, Coburg, Germany.|Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Sonia
S
Ammar-Busch
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Felix
F
Bourier
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Tilko
T
Reents
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Verena
V
Semmler
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Marta
M
Telishevska
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Susanne
S
Kathan
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Monika
M
Hofmann
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Gabriele
G
Hessling
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Isabel
I
Deisenhofer
D000200:Action Potentials; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D018572:Disease-Free Survival; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005858:Germany; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012815:Signal Processing, Computer-Assisted; D013997:Time Factors; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents
ablation; atrial fibrillation; complex fractionated atrial electrograms; lines