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Title: Additional left atrial septal line does not improve outcome of patients undergoing ablation for long-standing persistent atrial fibrillation
Author(s): E. Mikhaylov , S. Gureev , T. Szili-Torok , D. Lebedev
Journal: Acta Cardiologica
Volume: 65    Issue: 2   Date: 2010   
Pages: 153-160
DOI: 10.2143/AC.65.2.2047048

Abstract :
Objective — Additional septal linear ablation in patients undergoing ablation of long-standing persistent atrial fibrillation (AF) could be beneficial due to additional extensive atrial tissue ablation and incidental ablation of sites with complex fractionated electrograms. We assessed the long-term outcome of patients after ablation of long-standing persistent AF with an additional left atrial (LA) septal line.
Methods — Thirty-four patients were included. The patients were randomized into two groups and underwent pulmonary vein (PV) isolation with roof line, mitral isthmus line and coronary sinus ablation. In group 1 an additional LA septal line was created.
Results — AF converted into atrial tachycardia in 2 patients during septal ablation in group 1. In group 2 AF terminated via atrial tachycardia in 3 patients (P = ns). During a mean follow-up of 620 ± 119 days, 7 (41%) and 8 (47%) patients from group 1 and group 2 were free from recurrences (P = ns). Redo procedures were performed in 5 patients of group 1 and in 5 patients of group 2. For a follow-up of 349 ± 273 days after the last ablation, Cox’s F-test showed a trend of more recurrences in group 1 (P = 0.07).
Conclusions — In patients with long-standing AF, an additional LA septal linear ablation is not associated with a significantly higher AF termination rate. A septal linear lesion might increase the risk of septal reentrant tachycardias, and is associated with a trend towards a worse outcome.

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