• Sonia Ammar, Gabriele Hessling, Tilko Reents, Maria Paulik, Stephanie Fichtner, Patrick Schön, Roger Dillier, Susanne Kathan, Clemens Jilek, Christof Kolb, Bernhard Haller, and Isabel Deisenhofer.
• German Heart Center Munich, Munich, Germany. ammar@dhm.mhn.de
• J. Cardiovasc. Electrophysiol. 2013 Apr 1; 24 (4): 388-95.

BackgroundThe endpoint of persistent atrial fibrillation (AF) ablation is still a matter of debate. The purpose of this study was to evaluate if sinus rhythm (SR) as endpoint of persistent AF ablation has a better long-term outcome compared to atrial tachycardia (AT) or AF at the end of the procedure.Methods And ResultsBetween 2008 and 2011, 191 consecutive patients undergoing de novo catheter ablation for symptomatic persistent and long-standing persistent AF using a sequential ablation approach (including pulmonary vein isolation, ablation of complex fractionated electrograms and linear lesions) were included in the study. According to the result at the end of ablation procedure, patients were classified into 3 groups: patients with termination of AF into SR (Group 1, n = 62), patients with AT undergoing cardioversion (CV) (Group 2, n = 47), or patients with AF undergoing CV (Group 3, n = 82). The primary endpoint was freedom from any atrial tachyarrhythmia off antiarrhythmic drugs at 12 months. At 12 months, estimated proportions of patients free from any arrhythmia recurrence were 42% for Group 1, 13% for Group 2, and 25% for Group 3 (P = 0.002). In a Cox regression analysis only termination into SR was associated with a lower risk of arrhythmia recurrence (HR: 0.62; P = 0.04).ConclusionIf SR is achieved as endpoint of persistent and long-standing persistent AF ablation using a sequential ablation approach it is associated with the highest long-term single procedure success rate compared to AT or AF at the end of the procedure.© 2012 Wiley Periodicals, Inc.

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