Brooks, A.Stiles, M.Laborderie, J.Lau, D.Kuklik, P.Shipp, N.Hsu, L.Sanders, P.2010-10-282010-10-282010Heart Rhythm, 2010; 7(6):835-8461547-52711556-3871http://hdl.handle.net/2440/61531<h4>Background</h4>Ablation of long-standing persistent atrial fibrillation (AF) is highly variable, with differing techniques and outcomes.<h4>Objective</h4>The purpose of this study was to undertake a systematic review of the literature with regard to the impact of ablation technique on the outcomes of long-standing persistent AF ablation.<h4>Methods</h4>A systematic search of the contemporary English scientific literature (from January 1, 1990 to June 1, 2009) in the PubMed database identified 32 studies on persistent/long-standing persistent or long-standing persistent AF ablation (including four randomized controlled trials). Data on single-procedure, drug-free success, multiple procedure success, and pharmaceutically assisted success at longest follow-up were collated.<h4>Results</h4>Four studies performed pulmonary vein isolation alone (21%-22% success). Four studies performed pulmonary vein antrum ablation with isolation (PVAI; n = 2; 38%-40% success) or without confirmed isolation (PVA; n = 2; 37%-56% success). Ten studies performed linear ablation in addition to PVA (n = 5; 11%-74% success) or PVAI (n = 5; 38%-57% success). Three studies performed posterior wall box isolation (n = 3; 44%-50% success). Five studies performed complex fractionated atrial electrogram ablation (n = 5; 24%-63% success). Six studies performed complex fractionated atrial electrogram ablation as an adjunct to PVA (n = 2; 50%-51% success), PVAI (n = 3; 36%-61% success), or PVAI and linear (n = 1; 68% success) ablation. Five studies performed the stepwise ablation approach (38%-62% success).<h4>Conclusion</h4>The variation in success within and between techniques suggests that the optimal ablation technique for long-standing persistent AF is unclear. Nevertheless, long-standing persistent AF can be effectively treated with a composite of extensive index catheter ablation, repeat procedures, and/or pharmaceuticals.en© 2010 Heart Rhythm Society. All rights reserved.AblationAtrial fibrillationSystematic reviewLong-standing persistent atrial fibrillationJournal article002009776810.1016/j.hrthm.2010.01.0170002786083000222-s2.0-7795257315834175Lau, D. [0000-0001-7753-1318] [0000-0002-1564-439X]Kuklik, P. [0000-0001-8440-654X]Sanders, P. [0000-0003-3803-8429]