102 Arrhythmia recurrence following durable pulmonary vein isolation and posterior wall isolation in persistent atrial fibrillation: a randomised study

Introduction In patients with advanced persistent atrial fibrillation the optimal ablation strategy during redo procedures is unknown. The utility of posterior wall isolation (PWI) in addition to pulmonary vein isolation (PVI) in these patients remains uncertain. Methods 44 patients with PeAF or longstanding PeAF (mean age 63 ± 7.9 years, 77% male, median time since AF diagnosis 22.5 months, median indexed LA volume 36 ml/m2) were randomised to index radiofrequency PVI followed by protocol mandated redo at 2 months including PWI (PVI+PWI group) vs index cryoballoon PVI followed by protocol mandated redo without PWI (PVI-only group). Patients were followed-up with daily handheld ECG monitoring for 12 months, and quality of life (QOL) was assessed at baseline and 12 months using the EQ5D visual analogue scale (0 = worst, 100 = best). Results 38 patients underwent both procedures (n=17 PVI-only, n=21 PVI+PWI). Over median 338 days of follow-up, there was no difference in arrhythmia recurrence between the groups (PVI+PWI 38.1% vs PVI-only 41.2%; HR 0.84 [95% CI 0.31–2.33]; p=0.743). QOL was similar at baseline (median 70 per group, p=0.383), improved to 83 with PVI-only (p=0.041 vs baseline) and 80 with PVI+PWI (p=0.046 vs baseline), and did not differ between arms (p=0.616). QOL improved significantly in those without arrhythmia recurrence (p=0.005), but not in those with recurrence (p=0.158). Conclusion Patients with advanced persistent atrial fibrillation have a high rate of arrhythmia recurrence following PVI, even with a repeat invasive procedure to ensure PVI durability. Addition of PWI does not appear to improve outcomes. QOL improvement may depend upon ablation success. Conflict of Interest None