The Prognostic Role of Subsequent Atrial Tachycardias Occurring during Ablation of Persistent Atrial Fibrillation: A Prospective Randomized Trial

CIRCEP: October 25, 2013

Background—The role of subsequent atrial tachycardias (AT) in the context of persistent atrial fibrillation (AF) remains undetermined. This study evaluated the prognostic role of subsequent ATs for arrhythmia recurrences following catheter ablation of persistent AF.

Methods and Results—A total of 110 patients with persistent AF (63±9 y, 22 female, 61 long-lasting persistent AF) underwent pulmonary vein isolation followed by electrogram-guided ablation. After AF terminated to AT, patients were separated by the randomization protocol to receive either direct cardioversion (group A) or further ablation of subsequent ATs to sinus rhythm (SR) (group B). After a mean follow-up (FU) of 20.1±13.3 months after the first procedure, significantly more group B patients were in SR as compared to patients in group A (30 (57%) vs. 18 (34%), p=0.02). Moreover, recurrences of AF were significantly less frequent of group B than in group A patients (10 (19%) vs. 26 (49%), p=0.001). After the last procedure (FU 34.0±6.4 months), significantly more group B patients were free of AF as compared to patients of group A (49 (92%) vs. 39 (74%), p=0.01). The proportion of AT recurrences did not differ between the two groups after the first and final procedure. The strongest predictor for an arrhythmia free survival after a single procedure was randomization to the procedural endpoint of termination to SR by elimination of subsequent ATs (p=0.004). Read more