Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial-Part II (STAR AF II): design and rationale
Abstract
Background The optimal ablation approach for patients with persistent atrial fibrillation (AF) remains unknown. In particular, it is unclear if pulmonary vein (PV) antral isolation (PVI) is sufficient as a lone strategy for persistent AF. Furthermore, if additional substrate ablation is to be added, the ideal approach to substrate ablation is yet to be determined.Objective The aim of this study is to determine the optimal strategy of catheter ablation of persistent AF by comparing the efficacy of 3 strategies: PVI vs PVI plus complex fractionated electrogram (CFE) ablation (PVI + CFE) vs PVI plus linear ablation (PVI + Lines).Study design The STAR AF II study (ClinicalTrials.gov NCT01203748) is a prospective, multicenter, randomized trial with a blinded assessment of outcomes. A total of 549 patients will be randomized in a 1:4:4 fashion to one of the investigation arms: PVI, PVI + CFE, and PVI + Lines, respectively. Patients undergoing a first-time ablation procedure for symptomatic, persistent AF that is refractory to at least 1 antiarrhythmic medication will be included. Persistent AF will be defined as a sustained episode lasting >7 days and <3 years. Patients with a left atrial parasternal size ≥60 mm will be excluded. The primary end point is freedom from documented AF >30 seconds at 18 months after 1 or 2 ablation procedures with or without antiarrhythmic medications.Conclusions The STAR AF II study is a randomized trial designed to evaluate the optimal approach for catheter ablation of persistent AF.
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Complete pulmonary vein isolation on an atrial level is the best documented target for catheter ablation.
“Complete pulmonary vein isolation (PVI) on an atrial level is the best documented target for catheter ablation, 716,[729][730][731]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [730]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
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Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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- Authors
- Verma, A., Sanders, P., Macle, L., Deisenhofer, I., Morillo, C. A., Chen, J., Jiang, C.-Y., Ernst, S., & Mantovan, R.
- Affiliations
- Southlake Regional Health Center (CA)
- Royal Adelaide Hospital (AU)
- Montreal Heart Institute (CA)
- Deutsches Herzzentrum München (DE)
- Hamilton General Hospital (CA)
- Haukeland University Hospital (NO)
- Royal Brompton Hospital (GB)
- Ca' Foncello Hospital (IT)
- Corresponding author
- Verma, Atul
- ORCID
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2012-07
- Volume
- 164
- Issue
- 1
- Pages
- 1-6.e6
- ISSN
- 0002-8703 (ISSN-L)
- OpenAlex
- W2075373428
- Cited by
- 57
- References
- 28
- Citations by year
- 2026: 4 · 2024: 3 · 2023: 8 · 2021: 4 · 2020: 4 · 2018: 3 · 2017: 5 · 2016: 8 · 2015: 9 · 2014: 4 · 2013: 3
- FWCI
- 3.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- mediaTUM (Technical University of Munich) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- persistent atrial fibrillation, catheter ablation, linear ablation, substrate ablation, antiarrhythmic drugs, atrial fibrillation recurrence
- MeSH terms
- Atrial Fibrillation, Humans, Prospective Studies, Randomized Controlled Trials as Topic, Single-Blind Method, Catheter Ablation
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