Superwide Left Atrial Circumferential Ablation for Persistent Atrial Fibrillation: A Randomized Controlled Trial

It remains to be answered whether further enlargement of the isolation area in the left atrium (LA) could produce better effectiveness than pulmonary vein antrum isolation (PVAI) for treatment of atrial fibrillation (AF).

To assess the effectiveness of superwide left atrial circumferential ablation (SWLACA) for treatment of persistent AF (PeAF) through a randomized controlled study.

A total of 248 patients (male 63.7%, median age 65 years) with PeAF were randomly divided into the SWLACA group and PVAI group. The circumferential lines were located 2-3 cm from the PV ostia in the SWLACA group and approximately 1 cm in the PVAI group, respectively. The primary endpoint was the recurrence of atrial tachyarrhythmia after a single procedure.

Conduction block between LA and pulmonary veins (PVs) were achieved in all patients. The isolation areas were obviously larger in the SWLACA group (p < 0.001). Compared with the PVAI group, the SWLACA group was associated with a longer procedure duration (p = 0.013) and fluoroscopic time (p = 0.038). During the 12-month follow-up, the overall recurrence rate of atrial tachyarrhythmia after a single procedure was not significantly different between the two groups (21.0% vs 26.6%; p = 0.297). However, the SWLACA group had significantly fewer AF recurrences (12.9% vs. 25.0%; p = 0.015), and more atrial tachycardia recurrences (8.1% vs. 1.6%; p = 0.018). After multiple procedures, the SWLACA group had a significantly higher total arrhythmia recurrence-free rate (p = 0.030).

Compared with PVAI, although SWLACA did not significantly decrease the overall arrhythmia recurrence rate for PeAF, it was associated with a notable reduction in the recurrence of AF.