Catheter Ablation of Persistent Atrial Fibrillation Lasting within 1 Year: Importance of Localized Sources

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Purpose: The aim of this study was to investigate the possibility to localize the targeting sites of catheter ablation (CA) for persistent atrial fibrillation (PerAF). Methods: Sixty-two patients (61±9 years, 55 male) with PerAF lasting within 1 year undergoing CA were enrolled. CA included extensive encircling pulmonary vein isolation (EEPVI), atrial substrate ablation (ASA) guided by continuous fractionated atrial electrogram, and cavotricuspid isthmus ablation. ASA was performed until AF termination as its endpoint at the left atrial (LA) roof, LA bottom, LA septum, mitral annulus, left atrial appendage (LAA), in a sequence. Fibrillatory cycle length (AFCL) was measured in the LAA at each step. Results: AF was terminated in 44 patients (71%), including 10 during initial EEPVI and 34 during ASA. LA septum (14 patients) and the LAA (12 patients) were the sites of the greatest frequency for AF termination during ASA, and furthermore, there was no significant prolongation of AFCL before ablation at the AF termination area compared with before starting ASA (from 182±24 to 190±23 msec, p=0.18). Fifty-nine patients (95%) have been free from tachyarrhythmia during follow-up of 28±9 months after 1.3±0.5 ablation sessions. Conclusions: However CA including LASA was effective for maintaining SR, optimal ablation sites may be able to be more selected by targeting initiating triggers for AF perpetuated not so long.