Different techniques in catheter ablation (CA) of persistent (Pers) and longstanding (LS) Pers AF have been described with variable outcomes. We report long-term results in a series of Pers AF patients who underwent CA with magnetic navigation (MN).

We prospectively included 50 patients (pts; 43 males; 61±10 y) referred for CA of Pers AF. Pers and LS Pers AF were defined according to published guidelines. Freedom from AF is defined as the absence of symptomatic or ECG/Holter documented AF after ablation. All pts underwent stepwise CA using MN: circumferential pulmonary veins isolation, bi-atrial complex fragmented electrograms ablation, roof ± left isthmus ± cavo-tricuspid isthmus lines. Atrial tachycardia (AT) occurring during CA were also targeted.

Total duration of AF history was 56±42m (range 4 m-12 y, median 48m). Mean duration of continuous AF was 8±12m (range 1-84m, median 5.5m; 18% LS and 82% Pers AF). AF was lone in 50%. LA size was 30±5cm², CT-scan volume 139±51ml. Procedures’ duration was 256±56 minutes with a fluoroscopy time of 13±5 min. RF time was 47±27 min. AF stopped without electrical cardioversion in 17 pts (34%; sinus rhythm in 8 and AT in 9). A redo CA for recurring AF was performed in 6 pts (12%). Complications (4 pts) resolved w/o sequellae: acute coronary syndrome (1), pericardial effusion (1), AV fistula (1) and intraalveolar haemorrhage (1). After 19.9±9.5m (range 6-40, median 17.5m), with 1.1 procedures/pt, 40 pts (80%) had no AF recurrence, of which 28 were off AAD and 12 remained on AAD. Incidence of postablation AT was 12% (6/50).

Magnetic navigation for Pers AF ablation yields excellent (80%) long-term (20m) prevention of AF recurrence (figure next page).