Key result
Low-voltage isolation plus PVI linked to ~61% lower AT/AF recurrence risk than PVI alone.
Why the study?
Does the addition of low-voltage isolation or spatiotemporal dispersion ablation to pulmonary vein isolation improve freedom from atrial tachycardia or atrial fibrillation recurrence in patients with persistent atrial fibrillation?
Observational (n=210)
No
Does the addition of low-voltage isolation or spatiotemporal dispersion ablation to pulmonary vein isolation improve freedom from atrial tachycardia or atrial fibrillation recurrence in patients with persistent atrial fibrillation?
Effect estimate: HR 0.39 (95% CI 0.206-0.760)
Absolute Event Rate: 68% vs 40%
p-value: p=0.005
The addition of low-voltage isolation to pulmonary vein isolation significantly improved 18-month freedom from atrial arrhythmia recurrence in patients with persistent atrial fibrillation compared to PVI alone.
May support low-voltage isolation addition in persistent AF ablation; leaves open need for randomized confirmation before practice change.
the studied techniques between July 2016 and December 2019 were included in the study. PVI alone was compared with PVI plus SD and PVI plus LVI in terms of long-term freedom from atrial tachycardia (AT) and AF recurrence. Follow-up data were obtained from clinical records and hospital visits, which included a 7-day Holter monitor and electrocardiograms. The study was approved by the institutional review board of Rhode Island Hospital. A total of 382 patients underwent catheter ablation at our institution during the study period. One hundred seventy-two patients had paroxysmal AF and were excluded from the study. The remaining 210 patients had persistent AF and were included in the study. One hundred and three patients underwent PVI alone, while 48 had the addition of LVI and 59 had SD. Additionally, freedom from AT/AF recurrence at 18 months was 68% in the group that underwent LVI, 49% in the SD group, and 40% in the group that underwent PVI alone (log-rank P = .014). Freedom from AF recurrence was 74% in the LVI group, 71% in the SD group, and 43% in the PVI-alone group (log-rank P = .002). On multivariate Cox regression, LVI and left atrial size were found to be independent predictors of recurrence (hazard ratio, 0.39; 95% confidence interval, 0.206-0.760; P = .005 and hazard ratio, 1.4; 95% confidence interval, 1.105-1.923; P = .008, respectively). LVI and SD in addition to PVI were associated with greater freedom from AT/AF recurrence at 18 months compared to PVI alone.
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GARCIA et al. (2023) conducted an observational in Persistent Atrial Fibrillation (n=210). Pulmonary vein isolation plus low-voltage isolation vs. Pulmonary vein isolation alone was evaluated on Freedom from AT/AF recurrence at 18 months (HR 0.39, 95% CI 0.206-0.760, p=0.005). Low-voltage isolation in addition to pulmonary vein isolation significantly reduced the risk of atrial tachycardia or atrial fibrillation recurrence at 18 months compared to pulmonary vein isolation alone (HR 0.39).
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