Pulmonary vein isolation (PVI) is less effective in patients with persistent compared with paroxysmal AF.
However, a large multi-centre international study STAR 2 AF demonstrated that additional linear ablation or targeting of complex atrial activity did not improve procedural outcomes beyond PVI alone. Importantly this study did not include electrical isolation of the posterior left atrial wall. The LA posterior wall may be an important site in the maintenance of AF. Posterior wall isolation has the potential to improve clinical outcomes in patients with persistent AF through modification of autonomic ganglia, the inclusion of proximal rotors or regions of complex fractionated activity, de-bulking of the atrium and reinforcement of PVI.
Our prior study involving PVI plus posterior LA isolation that included 165 patients with persistent AF demonstrated freedom from recurrent atrial arrhythmia in 71 per cent after multiple procedures at a mean follow-up of 15±9 months. This project will be a multi-centre international randomised study in patients with persistent AF undergoing catheter ablation comparing PVI alone vs PVI+ post LA isolation.