Extensive electro-anatomic-guided ablation achieved the lowest 36-month rate of cardiovascular events (17.0%) and highest sinus rhythm maintenance (62.0%) in patients with persistent AF and HF.
Does extensive electrogram-anatomic-guided ablation reduce cardiovascular events and improve sinus rhythm maintenance compared to anatomic-guided or electrogram-guided ablation in patients with persistent atrial fibrillation and heart failure?
In patients with persistent AF and HF, an extensive electrogram-anatomic-guided ablation strategy provides superior long-term rhythm control and reduces cardiovascular events compared to anatomic or electrogram-guided approaches alone.
Absolute Event Rate: 0% vs 0%
BACKGROUND: Catheter ablation has been shown to improve prognosis in patients with heart failure (HF) and atrial fibrillation (AF); however, the optimal ablation strategy remains undefined. METHODS: In this multicenter, randomized controlled trial, 300 patients with persistent AF and HF, including both HF with reduced ejection fraction (EF ≤40%) and HF with preserved ejection fraction (EF >40%, including mid-range EF EF 41% to 50%), were enrolled and randomized equally to the anatomic-guided ablation, electrogram-guided ablation, and extensive electrogram-anatomic–guided ablation groups, with 100 patients in each group. The coprimary end points were: (1) the composite of cardiovascular death or HF-related hospitalization/urgent visit within 36 months; and (2) maintenance of sinus rhythm at 36 months. Secondary end points included AF burden <1%, New York Heart Association class improvement (≥1 grade), 6-minute walk test change, NT-proBNP (N-terminal pro-B-type natriuretic peptide) reduction, and procedure-related complications. Subgroup analyses were performed for HF with reduced ejection fraction and HF with preserved ejection fraction. RESULTS: At 36 months, the extensive electro-anatomic–guided ablation group demonstrated the lowest incidence of the composite end point (17.0%) compared with the electrogram-guided ablation (29.0%) and anatomic-guided ablation (36.0%; overall P =0.010) groups, and the highest rate of sinus rhythm maintenance (62.0%) compared with the electrogram-guided ablation (53.0%) and anatomic-guided ablation (44.0%; P =0.039) groups. Consistent improvements were observed for AF burden <1%, New York Heart Association class, 6-minute walk test, and NT-proBNP. Major complications were low and similar across all groups. These trends were consistent in both the HF with reduced ejection fraction and HF with preserved ejection fraction subgroups. CONCLUSIONS: Electrogram-anatomic ablation provides superior long-term rhythm control, reduces cardiovascular events, and improves symptoms in patients with persistent AF and HF, regardless of ejection fraction. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT07153718.
Li et al. (Tue,) reported a other. Extensive electro-anatomic-guided ablation achieved the lowest 36-month rate of cardiovascular events (17.0%) and highest sinus rhythm maintenance (62.0%) in patients with persistent AF and HF.