Long-standing persistent atrial fibrillation ablation

This chapter summarizes the ablation strategy approaches described in the literature for the treatment of long-standing persistent AF and more extensively the author's approach that we believe allows a better outcome at the long-term follow-up. Pulmonary vein electrical isolation (PVI) alone has dismal success rate at 2 years follow-up not exceeding 25%. The approach is that the most effective at the long-term follow-up includes in addition to PVI electrical isolation of the posterior wall, the roof, the coronary sinus, the left septum, and the left atrial appendage with or without CFAEs. The chapter presents preliminary data of long-standing persistent AF ablation while on rivaroxaban showing that it is as safe as warfarin. The "BELIEF" study (NCT01362738) randomizing patients with long-standing persistent atrial fibrillation to empirical LAA isolation plus standard approach versus standard approach without LAA isolation will clarify the relevance of the LAA isolation in patients with LSP.