Cited by 2,339Atrial Fibrillation Management and OutcomesCardiac Arrhythmias and TreatmentsCardiac pacing and defibrillation studies

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Approaches to Catheter Ablation for Persistent Atrial Fibrillation

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Verma, Atul, Jiang, Chen-yang, Betts, Timothy R., Chen, Jian, Deisenhofer, Isabel, Mantovan, Roberto, Macle, Laurent, Morillo, Carlos A., Haverkamp, Wilhelm, Weerasooriya, Rukshen, Albenque, Jean-Paul, Nardi, Stefano, Menardi, Endrj, Novak, Paul, Sanders, Prashanthan·2015·New England Journal of Medicine

DOI 10.1056/nejmoa1408288

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Abstract

BACKGROUND: Catheter ablation is less successful for persistent atrial fibrillation than for paroxysmal atrial fibrillation. Guidelines suggest that adjuvant substrate modification in addition to pulmonary-vein isolation is required in persistent atrial fibrillation. METHODS: We randomly assigned 589 patients with persistent atrial fibrillation in a 1:4:4 ratio to ablation with pulmonary-vein isolation alone (67 patients), pulmonary-vein isolation plus ablation of electrograms showing complex fractionated activity (263 patients), or pulmonary-vein isolation plus additional linear ablation across the left atrial roof and mitral valve isthmus (259 patients). The duration of follow-up was 18 months. The primary end point was freedom from any documented recurrence of atrial fibrillation lasting longer than 30 seconds after a single ablation procedure. RESULTS: Procedure time was significantly shorter for pulmonary-vein isolation alone than for the other two procedures (P<0.001). After 18 months, 59% of patients assigned to pulmonary-vein isolation alone were free from recurrent atrial fibrillation, as compared with 49% of patients assigned to pulmonary-vein isolation plus complex electrogram ablation and 46% of patients assigned to pulmonary-vein isolation plus linear ablation (P=0.15). There were also no significant differences among the three groups for the secondary end points, including freedom from atrial fibrillation after two ablation procedures and freedom from any atrial arrhythmia. Complications included tamponade (three patients), stroke or transient ischemic attack (three patients), and atrioesophageal fistula (one patient). CONCLUSIONS: Among patients with persistent atrial fibrillation, we found no reduction in the rate of recurrent atrial fibrillation when either linear ablation or ablation of complex fractionated electrograms was performed in addition to pulmonary-vein isolation. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT01203748.).

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Authors: Verma, A., Jiang, C.-Y., Betts, T. R., Chen, J., Deisenhofer, I., Mantovan, R., Macle, L., Morillo, C. A., Haverkamp, W., Weerasooriya, R., Albenque, J.-P., Nardi, S., Menardi, E., Novak, P., & Sanders, P.
Affiliations: Montreal Heart Institute (CA)
John Radcliffe Hospital (GB)
Haukeland University Hospital (NO)
Deutsches Herzzentrum München (DE)
Ospedale “M. Bufalini” di Cesena (IT)
McMaster University (CA)
Charité – Universitätsmedizin Berlin (DE)
Hollywood Private Hospital (AU)
Clinique Pasteur (FR)
Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo (IT)
Royal Jubilee Hospital (CA)
Royal Adelaide Hospital (AU)
ORCID: Verma, Atul
Betts, Timothy R.
Deisenhofer, Isabel
Mantovan, Roberto
Macle, Laurent
Morillo, Carlos A.
Haverkamp, Wilhelm
Albenque, Jean-Paul
Nardi, Stefano
Menardi, Endrj
Novak, Paul
Sanders, Prashanthan
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2015-05-07
Volume: 372
Issue: 19
Pages: 1812-1822
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa1408288
OpenAlex: W1583406651
Cited by: 2,339
References: 33
Citations by year: 2026: 162 · 2025: 191 · 2024: 213 · 2023: 176 · 2022: 253 · 2021: 186 · 2020: 231 · 2019: 222 · 2018: 205 · 2017: 227 · 2016: 193 · 2015: 71
FWCI: 168.71
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
UWA Profiles and Research Repository (UWA) (submittedVersion)
Adelaide Research & Scholarship (AR&S) (University of Adelaide) (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, pulmonary vein isolation, complex fractionated atrial electrograms, linear ablation, left atrial roof, atrial fibrillation recurrence
MeSH terms: Aged, Atrial Fibrillation, Electrocardiography, Female, Heart Atria, Humans, Male, Middle Aged, Mitral Valve, Pulmonary Veins, Recurrence, Stroke Volume, Proportional Hazards Models, Catheter Ablation, Disease-Free Survival, Kaplan-Meier Estimate, Secondary Prevention, Operative Time

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Approaches to Catheter Ablation for Persistent Atrial Fibrillation

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