Key result
PVI plus left atrial apex and vestibule ablation linked to ~37% lower AF/AT/AFL recurrence vs PVI.
Why the study?
The study sought to evaluate the efficacy and safety of 28 mm cryoballoon PVI combined with top left atrial linear ablation and pulmonary vein vestibular expansion ablation for persistent AF.
Does 28 mm cryoballoon PVI combined with left atrial apex and pulmonary vein vestibule ablation improve AF/AT/AFL-free survival in patients with persistent atrial fibrillation?
Cohort (n=413)
Does 28 mm cryoballoon PVI combined with left atrial apex and pulmonary vein vestibule ablation improve AF/AT/AFL-free survival in patients with persistent atrial fibrillation?
Effect estimate: HR 0.63 (95% CI 0.42 to 0.95)
Absolute Event Rate: 67.9% vs 56.3%
p-value: p=0.036
In patients with persistent atrial fibrillation, combining 28-mm cryoballoon PVI with linear ablation of the left atrial apex and expanded ablation of the pulmonary vein vestibule significantly improved AF/AT/AFL-free survival at 30 months compared to PVI alone.
May support adjunctive ablation in persistent AF; leaves open randomized confirmation before practice change.
OBJECTIVE: to retrospectively investigate the efficacy and safety of the application of 28 mm cryoballoon for pulmonary vein electrical isolation (PVI) combined with top left atrial linear ablation and pulmonary vein vestibular expansion ablation for persistent atrial fibrillation. METHODS: From July 2016 to December 2020, 413 patients diagnosed with persistent atrial fibrillation were evaluated, including 230 (55.7%) in the PVI group (PVI only) and 183 (44.3%) in the PVIPLUS group (PVI plus ablation of the left atrial apex and pulmonary vein vestibule). The safety and efficacy of the two groups were retrospectively analyzed. RESULTS: The AF/AT/AFL-free survival rates at 6, 12, 18, 24 and 30 months after procedure was 86.6%, 72.6%, 70.0%, 61.1% and 56.3% in the PVI group and 94.5%, 87.0%, 84.1%, 75.0% and 67.9% in the PVIPLUS group, respectively. At 30 months after procedure, the AF/AT/AFL-free survival rate was significantly higher in the PVIPLUS group than in the PVI group (P = 0.036; HR:0.63; 95% CI:0.42 to 0.95). CONCLUSION: The application of 28-mm cryoballoon for pulmonary vein electrical isolation combined with linear ablation of the left atrial apex and expanded ablation of the pulmonary vein vestibule improves the outcome of persistent atrial fibrillation.
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Lin et al. (2023) conducted a cohort in persistent atrial fibrillation (n=413). PVI combined with left atrial apex and pulmonary vein vestibule ablation (PVIPLUS) vs. PVI only was evaluated on AF/AT/AFL-free survival at 30 months (HR 0.63, 95% CI 0.42 to 0.95, p=0.036). PVI combined with left atrial apex and pulmonary vein vestibule ablation improved 30-month AF/AT/AFL-free survival compared to PVI alone (67.9% vs 56.3%; HR 0.63; 95% CI 0.42-0.95; P=0.036).
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