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  • Title: Is pursuit of termination of atrial fibrillation during catheter ablation of great value in patients with longstanding persistent atrial fibrillation?
    Author: Park YM, Choi JI, Lim HE, Park SW, Kim YH.
    Journal: J Cardiovasc Electrophysiol; 2012 Oct; 23(10):1051-8. PubMed ID: 22882600.
    Abstract:
    BACKGROUND: The reliable endpoint for ablation of longstanding persistent atrial fibrillation (LPAF) has not been clearly established. METHODS AND RESULTS: This study included 140 patients who underwent catheter ablation for drug-refractory LPAF. A stepwise ablation approach included circumferential pulmonary vein isolation followed by left atrial and right atrial complex fractionated electrogram-guided ablation. Atrial fibrillation (AF) was terminated by radiofrequency application during catheter ablation in 95 patients (67.9%). Among them, 33 patients (23.6%) converted to sinus rhythm directly, whereas 62 patients (44.3%) via atrial tachycardias (ATs). Patients in whom AF terminated during the index procedure had a lower recurrence rate of atrial arrhythmia than patients in whom AF did not terminate (45.3% vs 68.9%, P = 0.009, follow-up 18.7 ± 7.6 months). Among patients in whom AF terminated, there was no significant difference in recurrence rate according to the termination mode, whether converted to AT or not (P = NS). However, patients who converted to AT had a higher recurrence rate of AT (54.8% vs 81%; P = 0.016). Multivariable logistic regression analysis demonstrated that termination of AF during ablation (HR 0.440; 95% CI: 0.200-0.969, P = 0.041) and structural heart disease (HR 2.633; 95% CI: 1.211-5.723; P = 0.015) were significant independent factors predicting the recurrence of atrial arrhythmia. CONCLUSIONS: Termination of AF during catheter ablation is associated with a better clinical outcome in patients with LPAF.
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