Stepwise Approach Versus Linear Ablation in Patients With Recurrence of Persistent Atrial Fibrillation (REDO-AF)

Catheter ablation of persistent atrial fibrillation (AF) remains a challenging procedure. Even in experienced centres, repeat interventions are necessary in up to 70 of patients to achieve sinus rhythm at a long-term follow-up.

While there is a consensus to perform pulmonary vein isolation (PVI) as a cornerstone for the ablation of paroxysmal and persistent AF ablation, different additional ablation strategies are used to achieve a modification of the substrate that perpetuates the arrhythmia: linear lesions (anterior and roof lines) or ablation of complex fractionated atrial electrograms (CFAE). In the stepwise approach PVI, CFAE ablation and/or LL are combined according to the presenting arrhythmia during procedure.

The aim of the study is to determine whether there is a difference in terms of freedom from arrhythmia between a stepwise approach and a linear ablation for repeat procedure in patient with recurrence of persistent atrial fibrillation.

• Atrial Fibrillation
• Recurrence

• Procedure: Ablation with stepwise approach
  Stepwise approach for repeat AF ablation
• Procedure: Linear ablation
  Linear ablation for AF ablation

• Active Comparator: Stepwise approach
  Stepwise approach for repeat AF ablation
  Interventions:

  • Procedure: Ablation with stepwise approach
  • Procedure: Linear ablation
• Active Comparator: Linear ablation
  Linear ablation for repeat procedure in patients with recurrent atrial fibrillation
  Interventions:

  • Procedure: Ablation with stepwise approach
  • Procedure: Linear ablation

Inclusion Criteria:

• Patients with recurrence of symptomatic persistent atrial fibrillation after at least one ablation procedure,
• with the last ablation procedure at least 3 months ago.
• at least one unsuccessful attempt of antiarrhythmic drug
• oral anticoagulation for at least 4 weeks prior to ablation

Exclusion Criteria:

• LA thrombus