Long-standing persistent atrial fibrillation: The impact of intraprocedural AF termination on freedom of any atrial arrhythmia

Background: The prognostic role of intraprocedural AF termination into an atrial tachycardia (AT) using a modified stepwise approach is unclear with some studies suggesting improved arrhythmia-free outcome after intraprocedural AF termination. We compared long-term outcome of patients with AF termination after PVI+electrogram guided substrate ablation (EGSAbl) with patients who remained in AF after PVI +EGSAbl. Methods: The results of two randomized trials, the “ATTAC” and “ADLINE” trial, have been examined. A total of 208 patients underwent ablation using a modified stepwise approach with PVI+ EGSAbl (6linear ablation). AF of 123 patients (group 1) terminated intraprocedurally into AT (ATTAC collective) whereas 85 patients (group 2) remained in AF (ADLINE collective) after PVI+EGSAbl. Results: Freedom from AF recurrence following a single ablation was achieved in 85.1% of patients in group 1 and in 58.7% of patients in group 2 after 12 month (p=<0.001, figure 1a). Freedom from any arrhythmia after a single procedure was not different between the groups (p=0.807, figure 1b). However freedom from any arrhythmia after a mean of 2 procedures was achieved in 75.6% of patients in group 1 and in 59.4% of patients in group 2 (p=0.005, figure 1c) Discussion: Our data demonstrate that intraprocedural termination of AF to AT is associated with a more favourable outcome regarding freedom from any atrial arrhythmia after multiple procedures. In this setting, an interims stage with organisation of chaotic AF to organized AT seems necessary to restore durable SR and AT might be an acceptable endpoint of EGSAbl. (Figure Presented).