Radial Ablation for the Control of Persistent Atrial Fibrillation

Atrial fibrillation is the most common arrhythmia in clinical practice, and its treatment still remains suboptimal. Electrical isolation of the pulmonary veins with radiofrequency ablation or cryoablation is the standard therapy when antiarrhythmic drugs or electrical cardioversion is not successful. However, recurrence after catheter ablation worsens in persistent and permanent atrial fibrillation patients. Recently, rotational activity electrogram patterns of self-sustained electrical activity found in the atria have been proposed as the responsible mechanism for the maintenance of atrial fibrillation. The investigators devised a controlled, multicentric, prospective, not blinded, and randomized clinical trial with the aim of comparing pulmonary vein catheter ablation versus radial ablation of sites exhibiting rotational activity in patients with persistent atrial fibrillation. Radial ablation consists of the ablation of the rotational activity sites and an additional ablation line connecting the rotation site with the circumferential ablation line of the pulmonary veins.

Besides, subanalysis ARTIST-Gender and ARTIST-HF will be performed. ARTIST-Gender will compare the same outcomes and analysis of the patient cohort but according to the gender of the patient, and ARTIST-HF will sub-divide the analysis with respect to heart failure present in the enrolled patients' cohort.

Inclusion criteria

• Age ≥ 18 years and ≤ 75 years.
• Non-valvular symptomatic persistent atrial fibrillation.
• Patient willingness to participate in the study providing signed written informed consent.
• Failure or drug intolerance or refusal to continue with chronic antiarrhythmic treatment.
• Left ventricular ejection fraction LVEF) ≥ 25 % in the last echocardiogram prior to enrollment.

Exclusion criteria

• Left atrial diameter > 5.5 cm in the last echocardiogram.
• Contraindication of chronic anticoagulation or heparin.
• Previous atrial fibrillation ablation procedure.
• Acute coronary syndrome, cardiac surgery or acute cerebrovascular accident in two months prior to enrollement.
• Previous diagnosis for hyperthyroidism or hypothyroidism.
• Mental or physical illness that disables the patient to participate in the study.
• Scheduled cardiac percutaneous or surgical intervention.
• Non-controlled hypertension > 160/100.
• Terminal renal insufficiency or dialysis.
• Functional class IV of the New York Heart Association (NYHA).
• Moderate valvular disease or previous mitral prosthesis.
• Previous hypertrophic heart disease.
• Life expectancy less than 12 months.
• Inclusion on the transplant list.
• Participation in another study so as not to interfere with the results.
• Previous atrioventricular block.
• Pericardial effusion.
• Pregnancy or childbearing age without contraceptive treatment.