Background
Radiofrequency (RF) ablation is a widely accepted and effective therapy
in the management of atrial fibrillation (AF)1–3.
However, ablation of persistent atrial fibrillation remains a
therapeutic challenge, with recurrence rates of 30-60% at one year, and
a frequent need for repeat ablation.4–7 Improved
catheter stability results in more consistent catheter-tissue contact,
both allowing for more effective transmural lesion formation and
preventing excessive force that could result in cardiac perforation.
Furthermore, improved catheter stability has been shown to be associated
with decreased arrhythmia recurrence following AF
ablation.8 Multiple strategies and techniques exist
for improving catheter stability, including high frequency jet
ventilation9–11, steerable catheter
sheaths11–13, and rapid atrial
pacing14. However, catheter stability may be affected
by the underlying atrial rhythm. In patients with persistent AF,
achieving stable sinus rhythm and reliable atrial pacing may be
challenging prior to ablation, and pacing can only be performed in the
ventricle. It is unknown whether ablation in AF with ventricular pacing
versus in sinus rhythm (SR) with atrial pacing has any effects on
catheter stability, lesion quality, or clinical outcomes. In the present
study, we sought to compare the ablation characteristics and clinical
outcomes between patients with persistent AF who were mapped and ablated
in sinus rhythm with atrial pacing compared to atrial fibrillation with
ventricular pacing.