Does Atrial Fibrillation (AF) Termination Without Additional Ablation Influence Outcome?

Background: AF is a heterogeneous arrhythmia. At its simplest, it is triggered by rapidly
firing foci around pulmonary veins (PV) and can be cured by isolation of PV alone. Evidences
suggest that when high frequency of atrial activation is maintained for relatively longer
period (as in persistent or long-standing AF), ion channel remodeling changes the
electrophysiologic substrate and lead to AF permanence. Therefore, PVAI alone, as
anticipated, demonstrates to have limited success rate in persistent and LSP AF and
additional ablations beyond PVAI involving substrate modification are advocated by many
experts in electrophysiology. However, there is yet no consensus on the ablation strategy for
long-standing AF. It is still not clear whether AF termination during ablation could be
considered as an ablation endpoint or not, as earlier studies have reported results that are
at variance with each other. Some studies have suggested that termination of AF during
ablation is associated with reduced recurrence of arrhythmia while others detected no
association of AF termination with long-term maintenance of sinus rhythm (SR) in persistent
or LSP-AF.Therefore this study aims to examine ablation outcomes in LSP-AF patients with AF
termination with or without additional ablation of extra-PV triggers.

Hypothesis: AF termination does not eliminate the need for additional ablations in achieving
long-term ablation success in LSP-AF.

Inclusion Criteria:

1. Age ≥ 18 years

2. LSP-AF patients experiencing AF termination during ablation

3. Ability to understand and provide signed informed consent

Exclusion Criteria:

1. Previous left atrial catheter ablation or MAZE procedure in left atrium

2. Reversible causes of atrial arrhythmia such as hyperthyroidism, sarcoidosis, pulmonary
embolism etc