The value of extensive catheter linear ablation on persistent atrial fibrillation (the CLEAR-AF Study)

Int J Cardiol. 2020 Oct 1:316:125-129. doi: 10.1016/j.ijcard.2020.05.032. Epub 2020 May 24.

Abstract

Background: The ablation therapy for persistent atrial fibrillation (PerAF) is still a challenge due to the high recurrence rate. This study was aimed to investigate the value of extensive linear ablation with contact force sensing techniques for PerAF.

Methods: A total of 214 patients with PerAF were enrolled in five centers. The patients were randomly assigned to Group I (PVI + LA roof line+ LA anterior wall line) and Group II (PVI + LA roof line), mitral valve isthmus lines were added in both groups if the atrial fibrillation (AF) could not be terminated after all approaches above.

Results: Acute success rate of AF termination during the ablation procedure in Group I was significantly higher than Group II (P = 0.028). Two-years follow-up showed no significant difference in the sinus rhythm maintenance rate between the two groups (63.4% in group I vs. 57.2% in group II, P = 0.218). More patients in Group I recurred as organized atrial tachycardia (AT) and can be precisely mapped during repeat ablation procedures (15 vs. 2, P = 0.001). The Kaplan-Meier estimates of AF/AT-free survival after repeat ablation procedures were 76.2% in Group I and 47.1% in Group II (P = 0.039).

Conclusions: Extensive linear ablation with contact force monitoring did not improve the long-term outcomes for PerAF patients. Repeat ablation procedure showed a possible higher chance of sinus rhythm restoration during follow-up.

Keywords: Atrial fibrillation; Catheter ablation; Linear ablation; Persistent atrial fibrillation.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Atrial Fibrillation* / diagnostic imaging
  • Atrial Fibrillation* / surgery
  • Catheter Ablation*
  • Catheters
  • Humans
  • Pulmonary Veins* / surgery
  • Recurrence
  • Treatment Outcome