Catheter Ablation of Advanced Forms of Atrial Fibrillation

Patients with long-standing and persistent atrial fibrillation with severely dilated left atrium will undergo pulmonary vein isolation, box-lesion set of posterior wall, lateral mitral line (Marshall vein ablation and coronary sinus ablation per operator's discretion, anterior line, cavotricuspid line, superior caval vein isolation, intercaval line and inferior septal line. Ablations will be performed with either radiofrequency energy or pulsed field ablation at operator's discretion. Block at each line will be checked at the end of the procedure. The procedure will be performed with compliance of producer recommendation and hospital protocol.

All patients will be invited back at three months after index procedure for an invasive remap. At the remap procedure, pulmonary veins and posterior wall will be checked for isolation and all the additional lines will be checked for conduction block. Any gaps in lines will be ablated per operator's discretion.

Patients will undergo a period follow-up visit at 3, 6, and 12-month period. They will undergo a medical history taking, physical examination, ECG, and 7-day Holter ECG. Any documented atrial arrhythmia lasting more than 30 seconds after 8 week blanking period will be documented as a recurrence of atrial fibrillation.

Inclusion criteria

• persistent atrial fibrillation or long-standing persistent atrial fibrillation
• severely enlarged left atrium (LAVI above 50 ml/m2)

Exclusion criteria

• contraindications for electroporation
• contraindications for general anaesthesia
• age above 80 years
• less than 1 year life expectancy
• thrombus formation in left atrium
• acute life-threatening disease
• severe valvular disease requiring intervention
• previous ablation in left atrium
• secondary atrial fibrillation