Document Detail

Randomized ablation strategies for the treatment of persistent atrial fibrillation: RASTA study.
MedLine Citation:
PMID:  22139886     Owner:  NLM     Status:  MEDLINE    
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 follows: arm 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<0.001). The primary end point was achieved in 71 patients and was worse in arm 3 (29%) compared with arm 1 (49%; P=0.04) and arm 2 (58%; P=0.004).
CONCLUSIONS: These data suggest that additional substrate modification beyond PVI does not improve single-procedure efficacy in patients with persistent AF.
CLINICAL TRIAL REGISTRATION: URL: Unique identifier: NCT00379301.
Sanjay Dixit; Francis E Marchlinski; David Lin; David J Callans; Rupa Bala; Michael P Riley; Fermin C Garcia; Mathew D Hutchinson; Sarah J Ratcliffe; Joshua M Cooper; Ralph J Verdino; Vickas V Patel; Erica S Zado; Nancy R Cash; Tony Killian; Todd T Tomson; Edward P Gerstenfeld
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2011-12-02
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  5     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-18     Completed Date:  2012-06-12     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  287-94     Citation Subset:  IM    
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MeSH Terms
Atrial Fibrillation / surgery*
Catheter Ablation / methods*
Electrophysiologic Techniques, Cardiac
Follow-Up Studies
Middle Aged
Prospective Studies
Pulmonary Veins / surgery*
Treatment Outcome
Comment In:
Circ Arrhythm Electrophysiol. 2012 Dec;5(6):1224-32; discussion 1232   [PMID:  23250552 ]
Circ Arrhythm Electrophysiol. 2012 Apr;5(2):249-51   [PMID:  22511658 ]

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