Ablation of Complex Fractionated Electrograms With or Without ADditional LINEar Lesions for Persistent Atrial Fibrillation (The ADLINE Trial)

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The best approach to catheter ablation of persistent atrial fibrillation (AF) is still a matter of debate.1 Whereas pulmonary vein isolation (PVI) is the cornerstone of all techniques, different “add‐on” ablation concepts including linear lesions (LL) and ablation of complex fractionated atrial electrograms (CFAE) have been used for substrate modification.2 A stepwise ablation approach combining PVI+CFAE+LL ablation has been proposed by the Haissaguerre group,3 whereas another approach consists of the combination of PVI+CFAE only.4
Most AF ablation studies show that AF termination during ablation is associated with a better outcome.5 In patients without AF termination after PVI and CFAE, a more extended substrate ablation (including LL) to reach AF termination might offer a better ablation outcome.8
The aim of this study was to determine the benefit of additional LL in persistent AF patients without AF termination after PVI and CFAE regarding freedom from arrhythmia recurrence.
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