Outcomes After Optimized Complex Fractionated Atrial Electrograms-line(CFAE-LINE)ablation In Long-standing

Purpose:Radiofrequency catheter ablation has been the first-line treatment for symptomatic drug refractory atrial fibrillation.Because of the complicated trigger and maintenance,pulmonary vein isolation alone is insufficient for long-standing persistent atrial fibrillation.Complex fractionated atrial electrograms(CFAE)ablation is a strategy to modify the atrial substrate.However,since more fibrous scar occurred in the ablated area,the prevailing problem of CFAE ablation was the increased rate of untraceable postablation organized atrial tachyarrhythmias(AT).Connecting the CFAE ablation area and the electroanatomic barrier with linear(CFAE-LINE)ablation can reduce the recurrence of AT after ablation theoretically.We aimed to study the safety and efficiency of CFAE-LINE ablation for long-standing persistent atrial fibrillation and its effect on the postablation ATs.Methods:170 consecutive long-standing persistent AF patients underwent radiofrequency catheter ablation in our center from 2005 to 2015 were recruited in the study.Patients were eligible if they had symptomatic,drug-refractory long-standing persistent AF,and were undergoing radiofrequency catheter ablation for the first time.Long-standing persistent AF was defined as continuous AF lasting for ?1 year when it is decided to adopt a rhythm control strategy.After confirmed no contraindications by routine laboratory test,24 h Holter,X-ray,TEE,transthoracic echocardiography and CT scanning of pulmonary vein,the procedure was carried out with the CARTO mapping system.The patients were randomly assigned to the CFAE group(84 patients)or the CFAE-LINE group(86 patients)after PVI.Patients in the CFAE group underwent PVI+CFAE ablation,while patients in the CFAE-LINE group underwent PVI+“CFAELINE”ablation.During the follow-up,patients with recurrence of AF/AT underwent the repeat procedure using the same strategy of the first ablation.We mainly compared the recurrence of AF/AT.Success was defined free of any episode of atrial tachyarrhythmias lasting >30s recorded by ECG or Holter after the blanking period(3 months after the procedure).The duration of follow-up was the time between the day of the procedure and April 30,2016.Patients were followed clinically every 3 months within one year after procedure and every 6 months for the rest time with12-lead electrocardiograms and 24-hour Holter monitoring.ECG was performed in patients with palpitation or choking sensation in chest.Results1.The comparision of the two groups about gender,age,duration of AF,CHA2DS2-VASc score,BMI,echocardiography results(EF,LAD,LAVI)and complications(hypertension,cardiac dysfunction,diabetes,coronary heart disease,Cardiomyopathy,Congenital heart diseases)are without statistic significance(P>0.05).2.The duration of procedure,duration of radiofrequency,duration of fluoroscopy,AF termination rate,and the rate of cardioversion between the two groups had no statistically differences(P>0.05).3.One patient in the CFAE group had pericardial tamponade,and two patients in the CFAE-LINE group had pericardial tamponade.During the follow-up of 45.46±30 months,there was no stroke,pulmonary vein stenosis,atrial esophageal fistula occurred.4.A total of 222 procedures were performed.29 patients in the CFAE group underwent a second procedure(9 in AF,20 in AT).23 patients in the CFAE-LINE group underwent a second procedure(14 in AF,9 in AT).Of all patients undergoing the second procedure,AT recurrence rate in CFAE group is higher than CFAE-LINE group(24.4% vs 10.7%,P=0.02).5.The success rate of catheter ablation in CFAE-LINE group is higher than CFAE group statistically(73.8% va 51.2%,P=0.003).Patients in CFAE-LINE group has a lower recurrence rate of AT than CFAE group(10.7% vs 23.2%,P=0.032).There is no statistically difference of AF recurrence in the two groups(25.6% vs 15.4%,P=0.106).6.The Cox regression revealed the difference of group ? CHA2DS2-VASc score?operation times were risk factor of AF/AT rrecurrence.Conclusions1.The additional CFAE-LINE ablation is safe and efficient without increase of procedure time,radiofrequency time,fluoroscopy time and complications.2.In patients with long-standing persistent AF,a strategy of CFAE-LINE ablation reaches a higher success rate compared with the CFAE ablation.Recurrence of atrial tachyarrhythmias was reduced with the CFAE-LINE ablation.