Single-catheter simplified stepwise approach to persistent atrial fibrillation ablation: A feasibility study

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Persistent atrial fibrillation ablation strategies remain debated.
• Pulmonary vein isolation using a single-catheter approach has shown promise.

Purpose of the Study:

• To assess the feasibility of a single-catheter strategy for persistent atrial fibrillation ablation.
• To evaluate the inclusion of pulmonary vein isolation and additional atrial lines within this approach.

Main Methods:

• 159 patients with persistent atrial fibrillation underwent a prospective single-catheter ablation.
• Procedures included pulmonary vein isolation, with stepwise addition of atrial lines (roof, mitral, box, cavotricuspid isthmus) if needed.
• Direct-current cardioversion was used if atrial fibrillation persisted post-ablation.

Main Results:

• 36% of patients experienced atrial arrhythmia recurrence after a mean 17-month follow-up.
• Recurrence was mainly atrial fibrillation (75%) or atrial tachycardia (25%).
• The procedure demonstrated a favorable safety profile with no deaths or major complications.

Conclusions:

• A single-catheter approach is feasible and safe for persistent atrial fibrillation ablation.
• This strategy, incorporating pulmonary vein isolation and atrial lines, achieves a 64% mid-term success rate.
• The findings support the use of this technique in managing persistent atrial fibrillation.