A PRISM-guided ablation approach increased freedom from atrial arrhythmia recurrence at 12 months compared with a conventional approach (70.6% vs 47.1%; HR 0.53, 95% CI 0.33-0.85).
RCT (n=170)
1:1 ratio
Yes
Does PRISM mapping-guided catheter ablation added to PVI improve freedom from atrial arrhythmia in patients with persistent atrial fibrillation?
PRISM mapping-guided ablation significantly improves 12-month freedom from atrial arrhythmias compared to conventional ablation in patients with persistent atrial fibrillation.
Hazard Ratio: 0.53 (95% CI 0.33–0.85)
Absolute Event Rate: 70.6% vs 47.1%
Importance: Catheter ablation for persistent atrial fibrillation (AF) has shown limited success. Objective: To determine whether AF drivers could be accurately identified by periodicity and similarity (PRISM) mapping ablation results for persistent AF when added to pulmonary vein isolation (PVI). Design, Setting, and Participants: This prospective randomized clinical trial was performed between June 1, 2019, and December 31, 2020, and included patients with persistent AF enrolled in 3 centers across Asia. Data were analyzed on October 1, 2022. Intervention: Patients were assigned to the PRISM-guided approach (group 1) or the conventional approach (group 2) at a 1:1 ratio. Main Outcomes and Measures: The primary outcome was freedom from AF or other atrial arrhythmia for longer than 30 seconds at 6 and 12 months. Results: A total of 170 patients (mean SD age, 62.0 12.3 years; 136 men 80.0%) were enrolled (85 patients in group 1 and 85 patients in group 2). More group 1 patients achieved freedom from AF at 12 months compared with group 2 patients (60 70.6% vs 40 47.1%). Multivariate analysis indicated that the PRISM-guided approach was associated with freedom from the recurrence of atrial arrhythmia (hazard ratio, 0.53 95% CI, 0.33-0.85). Conclusions and Relevance: The waveform similarity and recurrence pattern derived from high-density mapping might provide an improved guiding approach for ablation of persistent AF. Compared with the conventional procedure, this novel specific substrate ablation strategy reduced the frequency of recurrent AF and increased the likelihood of maintenance of sinus rhythm. Trial Registration: ClinicalTrials.gov Identifier: NCT05333952.
Lin et al. (Wed,) conducted a rct in Persistent atrial fibrillation (n=170). PRISM-guided approach vs. Conventional approach was evaluated on Freedom from AF or other atrial arrhythmia for longer than 30 seconds at 6 and 12 months (HR 0.53, 95% CI 0.33-0.85). A PRISM-guided ablation approach increased freedom from atrial arrhythmia recurrence at 12 months compared with a conventional approach (70.6% vs 47.1%; HR 0.53, 95% CI 0.33-0.85).