• Julia Vogler, Stephan Willems, Arian Sultan, Doreen Schreiber, Jakob Lüker, Helge Servatius, Benjamin Schäffer, Julia Moser, Boris A Hoffmann, and Daniel Steven.
• Department of Electrophysiology, University Heart Center Hamburg, University Hospital Eppendorf, Hamburg, Germany. Electronic address: j.vogler@uke.de.
• J. Am. Coll. Cardiol. 2015 Dec 22; 66 (24): 2743-2752.

BackgroundLong-term success rates using ablation for persistent atrial fibrillation (AF) are disappointing and usually do not exceed 60%.ObjectivesThis study sought to compare arrhythmia-free survival between pulmonary vein isolation (PVI) and a stepwise approach (full defrag) consisting of PVI, ablation of complex fractionated electrograms, and additional linear ablation lines in the setting of atrial tachycardias (AT) in patients with persistent AF after PVI.MethodsFrom November 2010 to February 2013, 205 patients (151 men; 61.7 ± 10.2 years of age) underwent de novo ablation for persistent AF. Subsequently, patients were prospectively randomized to either PVI alone (n = 78) or full defrag (n = 75), with 52 patients not randomized due to AF termination with the original PVI. The primary endpoint was recurrence of any AT after a blanking period of 3 months.ResultsDuring the entire study, 241 ablations were performed (mean: 1.59 in the PVI-alone group, 1.55 in the full-defrag group). With the stepwise approach, termination of AF occurred in 45 (60%) patients. However, arrhythmia-free survival did not differ whether patients underwent single or multiple procedures (p = 0.468). Procedure duration, fluoroscopy time, and radiofrequency duration were significantly longer in the full-defrag group (all p < 0.001).ConclusionsA stepwise approach aimed at AF termination does not seem to provide additional benefit over PVI alone in patients with persistent AF, but it is associated with significantly longer procedural and fluoroscopic duration as well as radiofrequency application time. (The Randomized Catheter Ablation of Persist End Atrial Fibrillation Study [CHASE-AF]; NCT01580124).Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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