Randomized Ablation Strategies for the Treatment of Persistent Atrial Fibrillation: RASTA Study

BACKGROUND—The single-procedure efficacy of pulmonary vein isolation (PVI) is less than optimal in patients with persistent atrial fibrillation (AF). Adjunctive techniques have been developed to enhance single-procedure efficacy in these patients. We conducted a study to compare 3 ablation strategie...

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Veröffentlicht in:Circulation. Arrhythmia and electrophysiology 2012-04, Vol.5 (2), p.287-294
Hauptverfasser: Dixit, Sanjay, Marchlinski, Francis E, Lin, David, Callans, David J, Bala, Rupa, Riley, Michael P, Garcia, Fermin C, Hutchinson, Mathew D, Ratcliffe, Sarah J, Cooper, Joshua M, Verdino, Ralph J, Patel, Vickas V, Zado, Erica S, Cash, Nancy R, Killian, Tony, Tomson, Todd T, Gerstenfeld, Edward P
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Sprache:eng
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Zusammenfassung:BACKGROUND—The single-procedure efficacy of pulmonary vein isolation (PVI) is less than optimal in patients with persistent atrial fibrillation (AF). Adjunctive techniques have been developed to enhance single-procedure efficacy in these patients. We conducted a study to compare 3 ablation strategies in patients with persistent AF. METHODS AND RESULTS—Subjects were randomized as followsarm 1, PVI + ablation of non-PV triggers identified using a stimulation protocol (standard approach); arm 2, standard approach + empirical ablation at common non-PV AF trigger sites (mitral annulus, fossa ovalis, eustachian ridge, crista terminalis, and superior vena cava); or arm 3, standard approach + ablation of left atrial complex fractionated electrogram sites. Patients were seen at 6 weeks, 6 months, and 1 year; transtelephonic monitoring was performed at each visit. Antiarrhythmic drugs were discontinued at 3 to 6 months. The primary study end point was freedom from atrial arrhythmias off antiarrhythmic drugs at 1 year after a single-ablation procedure. A total of 156 patients (aged 59±9 years; 136 males; AF duration, 47±50 months) participated (arm 1, 55 patients; arm 2, 50 patients; arm 3, 51 patients). Procedural outcomes (procedure, fluoroscopy, and PVI times) were comparable between the 3 arms. More lesions were required to target non-PV trigger sites than a complex fractionated electrogram (33±9 versus 22±9; P
ISSN:1941-3149
1941-3084
DOI:10.1161/CIRCEP.111.966226