Key result
PVI plus mitral isthmus and posterior box isolation linked to ~38% lower arrhythmia recurrence versus PVI.
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?
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?
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.
Answers are grounded in this paper and cite their sources.
Supports adjunctive linear ablation in persistent AF ablation; leaves open randomized confirmation before practice change.
Background: For patients with persistent atrial fibrillation (AF), whether linear ablation should be performed remains controversial, and the efficacy and safety for ablation index (AI)-guided high-energy linear ablation of mitral isthmus (MI) and left atrial (LA) posterior box isolation is still unclear. The aims of this study were to assess the feasibility and clinical success rate of pulmonary veins isolation (PVI) combined with linear ablation of LA roof and posterior inferior (posterior wall isolation) and MI compare with the PVI-alone method in patients of persistent AF. Methods and results: 362 consecutive persistent AF patients were enrolled from two electrophysiology centers. A total of 200 cases were in PVI-plus group and 162 cases were in PVI-alone group. The PVI-alone group received wide circumferential isolation of both ipsilateral pulmonary veins. PVI combined with linear ablation of left atrial posterior wall isolation (LAPWI)and MI were performed in the PVI-plus group. The primary study end point was the first recurrence of an atrial arrhythmia. After 24 months, freedom from the primary endpoint was achieved in 73.5% of the patients in the PVI-plus group and 62.5% in the PVI-alone group (hazard ratio = 0.62, 95% confidence interval: 0.43–0.91, log rank p = 0.012). The procedure-related complication rates were 2.5% in PVI-plus group and 1.9% in PVI-alone group (p = 0.808). Conclusion: In this study, the ablation strategy of ablation (PVI plus linear ablation of mitral isthmus and posterior box isolation) was feasible and safe for persistent AF patients. Compared with the PVI-alone method, it improved outcomes in patients with persistent AF.
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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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