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August 6, 2021MedicineOpen Access

PVI plus CFAE ablation fails to improve 1-year atrial tachyarrhythmia-free survival over PVI alone.

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Why the study?

Does pulmonary vein isolation plus CFAE ablation within low voltage zones improve freedom from atrial tachyarrhythmia recurrence compared to PVI alone in patients with persistent atrial fibrillation?

Population

50 patients with persistent AF

Comparison

PVI plus CFAE ablation in low voltage zones vs PVI only

Design

Randomized trial

Follow-up

1-year

Key result

PVI plus CFAE ablation did not significantly improve 1-year atrial tachyarrhythmia-free survival compared to PVI alone (60.0% vs 40.0%, p=0.329), despite improving atrial fibrillation-free survival.

Authors

JHJongmin HwangHPHyoung‐Seob ParkSHSeongwook Han

Discussion

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Overview

PVI plus CFAE ablation does not improve atrial tachyarrhythmia-free survival; challenges its addition in persistent AF and leaves open strategies to reduce atrial tachycardia recurrences.

Key Points

  • This research evaluates the effectiveness of targeting complex fractionated atrial electrogram areas during persistent atrial fibrillation ablation in addition to pulmonary vein isolation.
  • Randomized 50 patients with persistent AF to either PVI + CFAE group or PVI only group in a 1:1 ratio.
  • Simultaneous CFAE and voltage mapping performed using a Pentaray Catheter with CARTO3 CONFIDENSE module.
  • Both groups underwent pulmonary vein isolation, while PVI + CFAE group targeted low voltage areas containing CFAEs for ablation.
  • In the PVI + CFAE group, 60% of patients converted to atrial tachycardia or sinus rhythm during the procedure.
  • 1-year AF free survival was significantly higher in the PVI + CFAE group at 84.0% compared to 44.0% in the PVI only group (P = .006).
  • AF/AT free survival was 60.0% for PVI + CFAE and 40.0% for PVI only, with no significant difference (P = .329).

Study Design

Type

RCT (n=50)

Randomization

1:1 ratio, blocked randomization sequence

Multicenter

No

Structured PICO

Does pulmonary vein isolation plus CFAE ablation within low voltage zones improve freedom from atrial tachyarrhythmia recurrence compared to PVI alone in patients with persistent atrial fibrillation?

P
Population
50 drug-refractory, symptomatic persistent and long-standing persistent atrial fibrillation (AF) patients (mean age 58.4 ± 9.5 years, 86.0% male) based in the Republic of Korea.
I
Intervention
Pulmonary vein isolation (PVI) plus ablation targeting complex fractionated atrial electrogram (CFAE) areas within low voltage zones (<0.5 mV) identified by high-density mapping.
C
Comparator
Pulmonary vein isolation (PVI) only.
O
Outcome
Freedom from any atrial tachyarrhythmia recurrence at the 1-year follow-up without antiarrhythmic drug treatment after a single ablation procedure.hard clinical

Main Result

Absolute Event Rate: 60% vs 40%

p-value: p=0.329

In patients with persistent AF, adding CFAE ablation within low-voltage zones to PVI improved 1-year AF-free survival but did not significantly improve overall atrial tachyarrhythmia-free survival due to increased atrial tachycardia recurrences.

Limitations

  • Small number of enrolled patients in a single center
  • Most patients were male
  • Baseline differences between groups in body mass index and AF duration
  • Ibutilide was not available
  • Long procedure and fluoroscopy times
  • Frequent recurrences of atrial tachycardia requiring multiple procedures
  • Differences between groups in body mass index and AF duration

Cite This Study

Hwang et al. (2021) conducted an RCT in Persistent and long-standing persistent atrial fibrillation (n=50). Pulmonary vein isolation (PVI) plus complex fractionated atrial electrogram (CFAE) ablation vs. PVI only was evaluated on Freedom from any atrial tachyarrhythmia recurrence at 1-year follow-up without antiarrhythmic drugs (p=0.329). PVI plus CFAE ablation did not significantly improve 1-year atrial tachyarrhythmia-free survival compared to PVI alone (60.0% vs 40.0%, p=0.329), despite improving atrial fibrillation-free survival.

synapsesocial.com/papers/6a11e5c2c031bb6829a58560https://doi.org/10.1097/md.0000000000026702
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