CPVI With Modified Linear Ablation Versus CPVI in Patients With Long-standing Persistent Atrial Fibrillation (SINUS)

Prior treatment

• Patients taking cephalosporin antibiotics within 72 hours prior to ablation;
• Patients who had undergone surgery within 6 months;

Other illness

• Left atrial thrombosis;
• Patients with a history of catheter ablation for AF;
• Patients with severe structural heart disease (severe valvular heart disease, hypertrophic cardiomyopathy, dilated cardiomyopathy, etc.);
• Alcohol allergy or contrast agent allergy;
• Patients with unstable angina pectoris;
• Patients ready to receive heart transplantation;
• Patients with a history of thromboembolism within 6 months;
• Patients with severe respiratory diseases;
• Patients with infectious diseases in active phase;
• Patients with poorly controlled systemic immune diseases;
• Patients with uncured malignant hematological diseases;
• Patients with uncured malignant solid tumors;
• Patients with end-stage renal failure requiring dialysis;
• Patients with other serious arrhythmias, such as ventricular tachycardia with hemodynamic instability;
• Patients with psychiatric ailments;

Lab values

• Left ventricular ejection fraction (LVEF) \< 40%;
• Patients with severe liver dysfunction (elevation of transaminases \[ALT or AST\] \>3 times the upper limit of normal range);

Age

• Persistent AF lasting \< 1 year or \>3 years;
• Life expectancy \< 2 years;

Other

• Paroxysmal atrial fibrillation;
• LAD \> 55mm on long axis parasternal view;
• Patients with contraindications to low molecular weight heparin, warfarin or novel oral anticoagulants;
• One-stop procedure for AF ablation and left atrial appendage occlusion;
• Pulmonary artery systolic pressure \> 50mmHg;
• Patients who had undergone percutaneous coronary intervention (PCI) within 3 months;
• Patients with diagnosed atrial myxoma;
• Patients with untreated hypothyroidism or hyperthyroidism;
• Pregnant and lactating women;
• BMI \< 18.5 or ≥ 30kg/m2;
• Patients unwilling or unable to give informed consent;
• Patients unwilling or unable to cooperate to complete follow-up.

• 1\. Patients with symptomatic LSPAF refractory to at least one antiarrhythmic drug; LSPAF will be defined as a sustained AF episode lasting ≥ 1 year;
• AF duration 1-3 years;
• Age 18 - 75 years;
• Left atrial diameter (LAD) 43-55 mm on long axis parasternal view;
• AF recorded within 3 years of enrollment;
• Patient willing and able to comply with protocol and sign informed consent