In Ablation of Persistent Atrial Fibrillation, More Is Not Necessarily Better

For the ablation of paroxysmal atrial fibrillation (AF), there is general consensus that the optimal initial strategy is electrical isolation of pulmonary veins (PVI). Whether PVI is best performed by radiofrequency, cryoablation, or potentially newer techniques is not entirely clear. However, for persistent and permanent AF, it is believed that PVI needs to be accompanied by more-extensive ablation — of roof and mitral lines, high-frequency potentials, or rotors. In an industry-funded trial, investigators in 12 countries randomized 589 individuals with persistent AF (mean age, 60; 78% men) to one of three radiofrequency ablation strategies: PVI alone, PVI plus roof and mitral linear ablation, or PVI plus ablation of high-frequency potentia…