Long‐Term Follow‐Up of Pure Linear Ablation for Persistent Atrial Fibrillation Without Circumferential Pulmonary Vein Isolation

Abstract

BACKGROUND: The long-term outcome of radiofrequency catheter ablation in persistent atrial fibrillation (AF) patients remains controversial due to different procedural strategies. This study aimed to present the clinical outcome of a pure linear ablation approach without circumferential pulmonary vein isolation (CPVI) over an extended (>5 years) follow-up period. METHODS: From January 2005 to December 2009, 120 consecutive patients (94 men; age, 53.6 ± 10.3 years) with drug-refractory persistent AF that underwent pure linear ablation using AF termination as the desired procedural endpoint were enrolled. RESULTS: In the primary procedure, sinus rhythm was restored by ablation in 75 (62.5%) patients, and the remaining 45 patients in whom AF could not be terminated by ablation received electrical cardioversion. During a median follow-up period of 5.1 (range 3.2-7.5) years, sinus rhythm was maintained in 48 (40.0%) patients without any antiarrhythmic drugs after a single procedure. There was a higher long-term success in the patients in whom AF was terminated by ablation than in those requiring cardioversion (49.3 vs. 24.4%; P = 0.007). CONCLUSION: Linear catheter ablation without CPVI is effective for persistent AF. Patients with AF terminated by ablation were associated with a better long-term outcome than those requiring cardioversion.