CFAE ablation plus ostial PVI was not superior to circumferential PVI plus lines for freedom from atrial tachyarrhythmia at 12 months (39% vs 37%; P=0.9).
RCT (n=116)
randomly assigned
Absolute Event Rate: 39% vs 37%
p-value: p=0.9
BACKGROUND: Catheter ablation of complex fractionated atrial electrograms (CFAE) for persistent atrial fibrillation (AF) is a promising treatment strategy. We tested the hypothesis that CFAE ablation is superior to linear ablation in patients with persistent or long-standing persistent AF. METHODS: In this study, 116 patients with persistent AF were randomly assigned to undergo circumferential PVI plus additional lines (linear ablation group; 59 patients) or CFAE ablation plus ostial pulmonary vein isolation (PVI) (spot ablation group; 57 patients). Primary endpoint was freedom from atrial tachyarrhythmia after a single ablation procedure (clinical and repeat 7-day Holter), 12 months after ablation without antiarrhythmic medication. RESULTS: The primary endpoint was reached in 22 of 59 (37%) patients of the linear ablation group and in 22 of 57 (39%) patients of the spot ablation group (P = 0.9). Freedom from atrial tachyarrhythmias, including reablations, was achieved in 54% of patients (linear ablation group) versus 56% of patients (spot ablation group; P = 0.8). The incidence of recurrent persistent AF was higher after linear ablation than after spot ablation (21/37 vs 11/35 patients; P = 0.03); atrial tachycardia (AT) was seen more often after spot ablation (10/35 vs 4/37 patients; P = 0.03). CONCLUSION: In patients with persistent AF, CFAE ablation plus PVI reaches the same results as circumferential PVI plus lines, in terms of freedom from symptomatic atrial tachyarrhythmias within the first year after a single ablation procedure. Arrhythmia recurrences in patients after spot ablation were caused more often by AT, whereas recurrent persistent AF was more prevalent after the linear ablation approach.
Estner et al. (Mon,) conducted a rct in persistent atrial fibrillation (n=116). CFAE ablation plus ostial pulmonary vein isolation (PVI) vs. Circumferential PVI plus additional lines was evaluated on Freedom from atrial tachyarrhythmia after a single ablation procedure at 12 months without antiarrhythmic medication (p=0.9). CFAE ablation plus ostial PVI was not superior to circumferential PVI plus lines for freedom from atrial tachyarrhythmia at 12 months (39% vs 37%; P=0.9).