Posterior Left Atrial Isolation Results in Fewer Arrhythmia Recurrences than Wide Antral Isolation: A Randomised Trial

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Introduction: Single ring electrical isolation of the posterior left atrium and the pulmonary veins (SRI) improved AF free survival but not atrial tachyarrhythmia free survival compared to wide antral pulmonary vein isolation (WAI) after one procedure. Outcomes of these techniques after repeat procedures are unclear. Methods: We randomly assigned 220 highly symptomatic AF patients (58±10 years old; 180 male; 135 paroxysmal, 85 persistent/longstanding persistent) to undergo either SRI or WAI, with or without additional left lateral mitral isthmus line (MIL) ablation. Patients with recurrences >3 months later were offered a repeat procedure then followed clinically and with 7-day Holter studies. Results: Over 2.4±0.9 years follow up 99 patients underwent a repeat procedure (15 required a third procedure and 3 required a fourth). SRI resulted in better 2-year atrial tachyarrhythmia free survival than WAI after up to 2 procedures (82±4% vs. 69±5% p=0.04) and after up to 4 procedures (88±3% vs. 76±4% p=0.04). However, MIL ablation did not affect survival rates after up to 2 or 4 procedures. Conclusions: SRI results in fewer recurrences than WAI on long term follow up after up to 2 or 4 procedures.
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