Cardioversion of Persistent Atrial Fibrillation Before High Energy Ablation Does Not Improve Outcomes in Short Term Follow Up: Preliminary Analysis

Introduction | Objectives: The optimal approach of ablating persistent Atrial Fibrillation (peAF) has yet to be defined. By convention, mapping/ablation of peAF is most often performed in AF. The success of ablation hinges on catheter contact and achieving lesion transmurality. We theorized that ablation efficacy would improve during sinus rhythm (SR) given stability and predictability of catheter contact.

Methods: Non-randomized comparison of peAF patients who underwent ablation in SR under a new practice protocol versus a cohort of peAF ablated in AF. The lesion set was the same for both groups, WACA ± BOX. Study group was treated with higher energy of 45 W vs 40 W for AF; impedance drop of 10 ohms to achieve pulmonary vein isolation (PVI).

Results: 54 patients mapped in AF were compared to 26 patients mapped in SR. There were no clinical differences in both groups except with time of follow up (Figure 1 ). At 150 days there appears to be a diverging difference between both groups (Figure 2 ); Log Rank Test: P  = 0.306 indicated no difference in time to AF recurrence.

Conclusions: Our preliminary data does not seem to support an advantaged or improved outcome using an ablation strategy in SR for this population. Accumulating data and further follow up are being employed to corroborate this observation and determine the most effective approach of ablating peAF.