Vigorous Sinus Restoration Strategy during Catheter Ablation for Persistent Atrial Fibrillation

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Backgrounds: Catheter ablation (CA) to achieve the procedural termination of persistent atrial fibrillation (AF) may to be quite limited especially in cases with trigger dominancy AF type and/or advanced LA remodeling. Methods: The study population consisted of consecutive 116 patients with persistent AF. At first, we cardioverted the AF to sinus rhythm (SR) just before PV isolation. If AF persistency and/or pacing inducible AF after 4PVs isolation, the further extensive CA was step-wisely performed. At the end of CA, SR was restored in all patients, and we assessed the residual burst-pacing AF (Rep-AF) inducibility. Results: The incidence of PVs arrhythmogenic foci (AFCs) were observed in 104 of 116 patients. The increased number of AFCs was significantly associated with the residual AFCs (2.3±1.2 vs. 3.0±1.2, p<0.05), and the residual AFCs was significantly associated with the increased AF recurrence (26% vs. 44%, p<0.05). Rep-AF was observed in 37 patients (33%), and was significantly associated with the increased AF recurrence. The clinical significance of Rep-AF for AF recurrence could be only observed in patients with the developed LA remodeling (>80 ml) (23% vs. 57%, p<0.05), and residual AFCs significantly pronounced the significance of Rep-AF for AF recurrence (52% vs. 28%, p<0.05). Conclusions: SR restoration strategy might reveal the latent AF characteristics to improve the outcome of CA for persistent AF.