Additional left atrial septal line does not improve outcome of patients undergoing ablation for long-standing...

Additional septal linear ablation in patients undergoing ablation of long-standing persistent atrial fibrillation (AF) could be beneficial due to additional extensive atrial tissue ablation and incidental ablation of sites with complex fractionated electrograms. We assessed the long-term outcome of patients after ablation of long-standing persistent AF with an additional left atrial (LA) septal line.

Thirty-four patients were included.The patients were randomized into two groups and underwent pulmonary vein (PV) isolation with roof line, mitral isthmus line and coronary sinus ablation. In group I an additional LA septal line was created.

AF converted into atrial tachycardia in 2 patients during septal ablation in group I. In group 2 AF terminated via atrial tachycardia in 3 patients (P = ns). During a mean follow-up of 620 +/- 119 days, 7 (41%) and 8 (47%) patients from group 1 and group 2 were free from recurrences (P = ns). Redo procedures were performed in 5 patients of group 1 and in 5 patients of group 2. For a follow-up of 349 +/- 273 days after the last ablation, Cox's F-test showed a trend of more recurrences in group 1 (P = 0.07).

In patients with long-standing AF, an additional LA septal linear ablation is not associated with a significantly higher AF termination rate. A septal linear lesion might increase the risk of septal reentrant tachycardias, and is associated with a trend towards a worse outcome.