Tailored bi-atrial linear ablation guided by electrophysiological mapping for persistent atrial fibrillation.

Aim: To explore the safety and efficacy of a novel strategy (bi-atrial linear catheter ablation guided by electrophysiological mapping) for persistent atrial fibrillation (PeAF) treatment.

Methods: 83 patients with PeAF were enrolled for evaluation of ablation strategy. 43 patients were subjected to pulmonary vein isolation (PVI) strategy (PVI group). 40 patients were subjected to bi-atrial linear ablation strategy guided by electrophysiological mapping (PVI, left atrial BOX ablation, coronary sinus endocardial linear ablation, tailored left atrial anterior wall linear ablation, mitral isthmus linear ablation with necessary ethanol infusion into the vein of Marshall, right atrial posterior wall linear ablation and cavo-tricuspid isthmus ablation) (linear ablation group). Patients were followed up every 3 months.

Results: During a median follow-up of 12 (4-16) months, freedom from atrial fibrillation/atrial tachycardia recurrence was 87.5% in the linear ablation group and 65.1% in the PVI group (P < 0.01). A Cox regression multivariate analysis revealed that ablation strategy group (tailored bi-atrial linear ablation) (HR 0.33, 95% CI 0.12-0.91, P = 0.03) was the only independent predictor of recurrence.

Conclusion: Tailored bi-atrial linear ablation strategy guided by electrophysiological mapping resulted in improved outcomes without compromising safety for patients with PeAF.