Why the study?
Whether linear ablation should be performed in persistent AF remains controversial, and the efficacy and safety of AI-guided high-energy linear ablation of the mitral isthmus and LA posterior box isolation are unclear.
Does PVI combined with linear ablation of the mitral isthmus and posterior box isolation reduce the first recurrence of atrial arrhythmia compared to PVI alone in patients with persistent atrial fibrillation?
Population
362 consecutive persistent AF patients from two electrophysiology centers
Comparison
PVI plus linear ablation (LAPWI and MI) vs PVI alone
Design
Two-center study
Follow-up
24 months
Key result
PVI plus linear ablation of the mitral isthmus and posterior box isolation improved freedom from atrial arrhythmia recurrence compared to PVI alone (73.5% vs 62.5%; HR 0.62; 95% CI 0.43-0.91; p=0.012).
Authors
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Supports adjunctive linear ablation in persistent AF ablation; leaves open randomized confirmation before practice change.
Cohort (n=362)
Yes
Does PVI combined with linear ablation of the mitral isthmus and posterior box isolation reduce the first recurrence of atrial arrhythmia compared to PVI alone in patients with persistent atrial fibrillation?
Effect estimate: HR 0.62 (95% CI 0.43-0.91)
Absolute Event Rate: 73.5% vs 62.5%
p-value: p=0.012
Ablation index-guided PVI combined with linear ablation of the mitral isthmus and posterior box isolation significantly reduced atrial arrhythmia recurrence compared to PVI alone in patients with persistent AF, without increasing complications.
Li et al. (2023) conducted a cohort in Persistent atrial fibrillation (n=362). PVI plus linear ablation of left atrial posterior wall isolation and mitral isthmus vs. PVI alone was evaluated on Freedom from first recurrence of an atrial arrhythmia (HR 0.62, 95% CI 0.43-0.91, p=0.012). PVI plus linear ablation of the mitral isthmus and posterior box isolation improved freedom from atrial arrhythmia recurrence compared to PVI alone (73.5% vs 62.5%; HR 0.62; 95% CI 0.43-0.91; p=0.012).
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