An additional left atrial septal line during ablation for long-standing persistent AF did not significantly improve freedom from recurrences compared to standard ablation (41% vs 47%, P=ns).
RCT (n=34)
randomized
Does an additional left atrial septal line improve freedom from recurrences in patients undergoing ablation for long-standing persistent atrial fibrillation?
Adding a left atrial septal line to standard ablation for long-standing persistent AF does not improve termination rates or long-term freedom from recurrence, and may increase the risk of septal reentrant tachycardias.
Absolute Event Rate: 41% vs 47%
p-value: p=ns
OBJECTIVE: Additional septal linear ablation in patients undergoing ablation of long-standing persistent atrial fibrillation (AF) could be beneficial due to additional extensive atrial tissue ablation and incidental ablation of sites with complex fractionated electrograms. We assessed the long-term outcome of patients after ablation of long-standing persistent AF with an additional left atrial (LA) septal line. METHODS: Thirty-four patients were included.The patients were randomized into two groups and underwent pulmonary vein (PV) isolation with roof line, mitral isthmus line and coronary sinus ablation. In group I an additional LA septal line was created. RESULTS: AF converted into atrial tachycardia in 2 patients during septal ablation in group I. In group 2 AF terminated via atrial tachycardia in 3 patients (P = ns). During a mean follow-up of 620 +/- 119 days, 7 (41%) and 8 (47%) patients from group 1 and group 2 were free from recurrences (P = ns). Redo procedures were performed in 5 patients of group 1 and in 5 patients of group 2. For a follow-up of 349 +/- 273 days after the last ablation, Cox's F-test showed a trend of more recurrences in group 1 (P = 0.07). CONCLUSIONS: In patients with long-standing AF, an additional LA septal linear ablation is not associated with a significantly higher AF termination rate. A septal linear lesion might increase the risk of septal reentrant tachycardias, and is associated with a trend towards a worse outcome.
Mikhaylov et al. (Fri,) conducted a rct in long-standing persistent atrial fibrillation (n=34). Additional left atrial septal line vs. Standard ablation (pulmonary vein isolation with roof line, mitral isthmus line and coronary sinus ablation) was evaluated on Freedom from recurrences (p=ns). An additional left atrial septal line during ablation for long-standing persistent AF did not significantly improve freedom from recurrences compared to standard ablation (41% vs 47%, P=ns).