What question did this study set out to answer?

To evaluate whether adding low-voltage area (LVA) ablation after posterior left atrial Box isolation (BOXI) improves outcomes in persistent atrial fibrillation patients with LVAs.

February 15, 2019Journal of ArrhythmiaOpen Access

Effects of additional ablation of low‐voltage areas after Box isolation for persistent atrial fibrillation

Q: What are the key findings of this study?

Additional low-voltage area ablation after Box isolation did not improve arrhythmia-free survival vs Box isolation alone in persistent AF (67% vs 62%, p=0.722).

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Persistent atrial fibrillation (n=115). Intervention: Box isolation (BOXI) plus low-voltage area (LVA) ablation vs. Box isolation (BOXI) alone. Primary outcome: Atrial tachyarrhythmia-free rate after a single procedure (p=0.722).

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Key result

Additional low-voltage area ablation fails to improve arrhythmia-free survival over Box isolation in persistent AF.

P=0.722
n=115

Why the study?

Whether low-voltage area ablation provides additional benefit beyond posterior left atrial isolation (Box isolation) in patients with persistent atrial fibrillation and low-voltage areas remained unclear.

Does BOXI plus LVA ablation improve atrial tachyarrhythmia-free survival compared to BOXI alone in patients with persistent atrial fibrillation and LVAs?

Key Points

To evaluate whether adding low-voltage area (LVA) ablation after posterior left atrial Box isolation (BOXI) improves outcomes in persistent atrial fibrillation patients with LVAs.
Assessed 115 patients with persistent atrial fibrillation (75 longstanding) who underwent left atrial voltage mapping and Box isolation (BOXI) following pulmonary vein isolation (PVI).
Treated 61 patients without LVAs (<0.5 mV) with BOXI alone, while 54 patients with LVAs were randomly assigned to BOXI plus LVA ablation (n=33) or BOXI alone (n=21) over 24 ± 9 months of follow-up.
AF termination or cardioversion rates were higher after BOXI compared to PVI alone (100% vs 88%, P < 0.001), and tachyarrhythmia inducibility dropped significantly (27% vs 100%, P < 0.001).
Patients with LVAs had a lower single-procedure tachyarrhythmia-free rate at follow-up than those without LVAs (65% vs 82%, P = 0.043).
Among patients with LVAs, arrhythmia-free survival did not differ significantly between BOXI plus LVA ablation and BOXI alone (67% vs 62%, P = 0.722).

Study Design

Type

RCT (n=115)

Blinding

Open-label

Randomization

Randomly assigned

Multicenter

Structured PICO

Does BOXI plus LVA ablation improve atrial tachyarrhythmia-free survival compared to BOXI alone in patients with persistent atrial fibrillation and LVAs?

Population

115 patients with persistent atrial fibrillation (PerAF), including 75 with longstanding PerAF. The randomized cohort consisted of 54 patients with low-voltage areas (LVAs).

Intervention

Box isolation (BOXI) plus low-voltage area (LVA) ablation

Comparator

Box isolation (BOXI) alone

Outcome

Atrial tachyarrhythmia-free rate (success rate) during follow-uphard clinical

Main Result

Absolute Event Rate: 67% vs 62%

p-value: p=0.722

Additional ablation of low-voltage areas after Box isolation does not significantly improve atrial tachyarrhythmia-free survival in patients with persistent atrial fibrillation and low-voltage areas.

Limitations

Single center study
Relatively small sample size
Asymptomatic recurrences may have been missed without implanted loop recorders

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Additional LVA ablation after Box isolation offers no benefit in persistent AF; challenges routine substrate modification.

Cite This Study

Kumagai et al. (2019) conducted an RCT in Persistent atrial fibrillation (n=115). Box isolation (BOXI) plus low-voltage area (LVA) ablation vs. Box isolation (BOXI) alone was evaluated on Atrial tachyarrhythmia-free rate after a single procedure (p=0.722). Additional low-voltage area ablation after Box isolation did not improve arrhythmia-free survival vs Box isolation alone in persistent AF (67% vs 62%, p=0.722).

synapsesocial.com/papers/6a0ec195aa1655e5fb22c168 https://doi.org/10.1002/joa3.12169

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

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Effects of additional ablation of low‐voltage areas after Box isolation for persistent atrial fibrillation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

Effects of additional ablation of low‐voltage areas after Box isolation for persistent atrial fibrillation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider