Prospective randomized comparison between a fixed ‘2C3L’ approach vs. stepwise approach for catheter ablation of persistent atrial fibrillation

Abstract

For catheter ablation of persistent AF, the '2C3L' strategy is a fixed approach associated with clinical efficacy similar to that of the 'stepwise' approach but with less RF delivery, fewer X-ray exposure, and shorter procedural time.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Początkowo PVI zbadano u pacjentów z napadowym AF, ale wydaje się, że również w przetrwałym AF jest to metoda nie gorsza niż bardziej rozległa ablacja [729,735]. U pacjentów z przetrwałym AF wykonywano także bardziej rozległe zabiegi ablacji, ale nie ma wystarczających danych, by obecnie sformułować zalecenia dotyczące ich wykonywania [117,718,719,[735][736][737]. Rozległe zabiegi ablacji (wykraczające poza PVI) zawsze wymagają dłuższego czasu trwania zabiegu i większej ekspozycji na promieniowanie jonizujące, co potencjalnie stwarza zagrożenie dla pacjentów.…”

No Benefit of Complex Fractionated Atrial Electrogram Ablation in Addition to Circumferential Pulmonary Vein Ablation and Linear Ablation

“…30 In their study, the authors also included a cavotricuspid isthmus line in their lesion set. Their 12-month single-procedural success rates were 60% versus 67%.…”

Stepwise ablation approach versus pulmonary vein isolation in patients with paroxysmal atrial fibrillation: Randomized controlled trial

“…It has been reported that additional lesions after PVI increase the success rate of freedom from arrhythmia (9). A possible explanation for this result is that linear ablation will likely interrupt macro re-entrant circuit of AT (19,20).…”

“…This might be explained by the older age and higher prevalence of hypertension, diabetes and a higher left atrial mean size of our sample and, at least in part, by the use of a strict evaluation of atrial arrhythmia recurrences (48-hour Holter every month). Furthermore, two recent studies, that used PVI alone or together with extensive ablation in patients with persistent AF, have reported dissimilar findings suggesting no additional clinical benefits in patients undergoing a more extensive ablation (19,20). There are some potential explanations for such a discrepancy: the STAR AF II trial did not compare PVI to a stepwise ablation approach, and the outcome at the end of the first ablation was not sinus rhythm restoration and non-inducibility of further atrial arrhythmias (19).…”