Left Roof Linear, Mitral Isthmus Linear and Left Anterior Septal Linear Ablation for Non-paroxysmal AF: PROMISED Trial.

Circumferential pulmonary vein isolation (CPVI) is an important radiofrequency catheter ablation strategy for AF. The recurrence rate of non-paroxysmal AF (non-PAF) after CPVI remains unsatisfactory, despite the use of additional strategies, such as linear ablation and complex fractionated atrial electrogram ablation. Non-PAF initiation and maintenance depend on a critical mass, which allows reentry. The left atrial anterior wall contains a series of substrates that are associated with AF, such as low-voltage zones, Bachmann's bundle, and the LAA, which are important for AF initiation and maintenance. Combining CPVI with left RL, left ASL, and MIL ablation can create a box lesion set on the anterior wall which compartmentalize the left atrial anterior wall into small regions to modify the substrate. We hypothesized that this substrate modification strategy would improve the success rate of non-PAF ablation. However, functional damage to the LAA resulting from the above-mentioned ablation strategy may increase stroke risk. The combined use of AF ablation and LAA occlusion is safe and can reduce stroke risk. Therefore, we examined the safety, feasibility, and efficacy of a new treatment strategy for non-PAF, defined as the CPVI; left ROof linear, Mitral Isthmus linear, and left anterior SEptal linear ablation; and LAA Device occlusion (PROMISED) procedure. Cases were prospectively treated in a 2-arm 1:1 design according to ablation strategy, divided into the Promised group (n = 83) or the PVI combined LAAC group (n =83).

• Recurrence of AF after a single ablation procedure [Срок оценки: 12 months after the first procedure]
• Recurrence of atrial flutter/atrial tachycardia after a single ablation [Срок оценки: 12 months after the first procedure]
• Occurrence of Intra-procedure conversion of persistent AF to sinus rhythm rate and Its Relationship to 1-Year Sinus Rhythm Maintenance Rate [Срок оценки: 12 months after the first procedure]
• Occurrence of Intra-procedure Conversion from AF to Atrial Flutter or Atrial Tachycardia rate and Its Relationship to 1-Year Sinus Rhythm Maintenance Rate [Срок оценки: 12 months after the first procedure]
• Incidence of periprocedural complications [Срок оценки: period of Post-operative to hospital discharge]
• post-procedure complications [Срок оценки: 12 months after the first procedure]
• Procedure duration of three-dimensional reconstruction of the left atrial [Срок оценки: At the end of the first procedure]
• Procedure duration at ablation [Срок оценки: At the end of the first procedure]
• Procedure duration at LAAC [Срок оценки: At the end of the first procedure]
• Incidence of events including device-related thrombus and peri-device leak at 3 months post-procedure [Срок оценки: 3 months after the first procedure]
• Anticoagulant discontinuation rate at 6 months post-procedure [Срок оценки: 6 months after the first procedure]