Randomized ablation strategies for the treatment of persistent atrial fibrillation RASTA study

Sanjay Dixit, Francis E. Marchlinski, David Lin, David J. Callans, Rupa Bala, Michael P. Riley, Fermin C. Garcia, Mathew D. Hutchinson, Sarah J. Ratcliffe, Joshua M. Cooper, Ralph J. Verdino, Vickas V. Patel, Erica S. Zado, Nancy R. Cash, Tony Killian, Todd T. Tomson, Edward P. Gerstenfeld

Research output: Contribution to journalArticlepeer-review

201 Scopus citations


Background-The single-procedure efficacy of pulmonary vein isolation (PVI) is less than optimal in patients with persistent atrial fibrillation (AF). Adjunctive techniques have been developed to enhance single-procedure efficacy in these patients. We conducted a study to compare 3 ablation strategies in patients with persistent AF. Methods and Results-Subjects were randomized as follows: arm 1, PVI + ablation of non-PV triggers identified using a stimulation protocol (standard approach); arm 2, standard approach + empirical ablation at common non-PV AF trigger sites (mitral annulus, fossa ovalis, eustachian ridge, crista terminalis, and superior vena cava); or arm 3, standard approach + ablation of left atrial complex fractionated electrogram sites. Patients were seen at 6 weeks, 6 months, and 1 year; transtelephonic monitoring was performed at each visit. Antiarrhythmic drugs were discontinued at 3 to 6 months. The primary study end point was freedom from atrial arrhythmias off antiarrhythmic drugs at 1 year after a single-ablation procedure. A total of 156 patients (aged 59±9 years; 136 males; AF duration, 47±50 months) participated (arm 1, 55 patients; arm 2, 50 patients; arm 3, 51 patients). Procedural outcomes (procedure, fluoroscopy, and PVI times) were comparable between the 3 arms. More lesions were required to target non-PV trigger sites than a complex fractionated electrogram (33±9 versus 22±9; P<0.001). The primary end point was achieved in 71 patients and was worse in arm 3 (29%) compared with arm 1 (49%; P=0.04) and arm 2 (58%; P=0.004). Conclusions-These data suggest that additional substrate modification beyond PVI does not improve single-procedure efficacy in patients with persistent AF.

Original languageEnglish (US)
Pages (from-to)287-294
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Issue number2
StatePublished - Apr 2012
Externally publishedYes


  • Ablation
  • Atrial fibrillation
  • Catheter ablation
  • Clinical trials

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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