Introduction: Pulmonary vein isolation (PVI) is an established strategy for paroxysmal atrial fibrillation (AF) but seemed to be less effective in patients with persistent AF. Some researchers had already suggested that additional ganglionated plexi (GP) ablation might improve the success rate. The aim of our study was to assess the maintenance of sinus rhythm (SR) in patients with longstanding persistent AF at least 3 years using 2 different ablation strategies, PVI plus linear lesions (LL) versus PVI plus GP ablation.
Methods: Two hundred sixty four consecutive patients with longstanding persistent AF were randomly assigned to 2 different ablation schemes: PVI plus LL (n=132) and PVI plus GP ablation (n=132). Primary end point was to assess the maintenance of SR after procedures in a long-term follow-up of at least 3 years.
Results: All cases underwent the procedure successfully. PVI was achieved in all cases. With a single procedure at the 12-month follow-up, 47% of patients treated with PVI plus LL were in SR, whereas at the 3-year follow-up, 34% maintained SR; using the PVI plus GP with a single procedure at the 12-month follow-up 54% of patients were in SR (p=0.068), whereas at the 3-year follow-up, 49% remained in SR (p=0.021). Atrial flutter was more frequent in the group of PVI plus LL than in PVI plus GP ablation group (11% versus 4%, P=0.036). After a second procedure, the long-term overall success rate was 52% with PVI plus LL and 68% with PVI plus GP ablation (p=0.018).
Conclusions: The difference between PVI plus LL and PVI plus GP ablation strategy is not statistically significant at 12 months in patients with longstanding persistent AF, whereas the difference becomes statistically significant in the longterm follow-up because of the higher number of recurrences in the PVI plus LL group.