Key result
Enhanced PVI endpoint cuts 12-month AF recurrence by an absolute ~21% vs observation.
Why the study?
It was unknown whether an enhanced endpoint of pulmonary vein isolation combining intravenous adenosine-triphosphate, pacing capture, and supplemental ablation could reduce long-term atrial fibrillation recurrence after initial ablation.
Does the enhanced endpoint of pulmonary vein isolation using ATP injection and pacing capture reduce atrial fibrillation recurrence in patients with paroxysmal or persistent AF undergoing catheter ablation?
RCT (n=293)
Randomly divided
No
Does the enhanced endpoint of pulmonary vein isolation using ATP injection and pacing capture reduce atrial fibrillation recurrence in patients with paroxysmal or persistent AF undergoing catheter ablation?
Using an enhanced endpoint of PVI with ATP injection and pacing capture significantly reduces long-term AF recurrence after catheter ablation.
Enhanced PVI endpoints with ATP and pacing may be adopted to lower post-ablation AF recurrence; extends randomized evidence on optimized ablation strategies.
OBJECTIVE: This study aimed to investigate whether the enhanced endpoint of pulmonary vein isolation (PVI; intravenous injection of adenosine-triphosphate [ATP] + pacing capture + supplemental ablation) after initial PVI can reduce the long-term recurrence rate of atrial fibrillation (AF) after PVI. METHODS: Patients with paroxysmal or persistent AF undergoing catheter ablation treatment were enrolled in this study and divided into three groups according to the surgical endpoint: (1) group 1 (n = 92), in which patients were observed for 30 minutes after the initial PVI and pulmonary vein-left atrium (PV-LA) electrical conduction had not recovered; (2) group 2 (n = 99), in which patients were observed for 30 minutes after the initial PVI, then intravenously injected with ATP, and PV-LA electrical conduction had not recovered; and (3) group 3 (n = 102), in which patients were observed for 30 minutes after the initial PVI, then intravenously injected with ATP + treated with ablation line pacing, and the atrium could not be captured. RESULTS: Patients were followed up for 12 months after the operation. Twenty-eight patients in group 1 (30.4%), 19 patients in group 2 (19.2%), and 10 patients in group 3 (9.8%) developed a recurrence of AF. The difference between groups 1 and 3 was statistically significant (p < 0.001). At 12 months after the operation, the thickness of the left atrium, the posterior wall of the left ventricle, and the ventricular septum of the three groups of patients were significantly thinner than before the operation. Furthermore, the left ventricular ejection fraction had increased (p < 0.05 for all), and the pulmonary artery pressure had decreased (p < 0.001). CONCLUSION: For patients with paroxysmal AF or persistent AF, the enhanced endpoint of PVI after the initial PVI can reduce the long-term recurrence rate of AF after PVI.
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Chen et al. (2021) conducted an RCT in Paroxysmal or persistent atrial fibrillation (n=293). Adenosine triphosphate (ATP) injection + pacing capture + supplemental ablation (Enhanced endpoint) vs. 30 minutes observation + supplemental ablation was evaluated on Recurrence of atrial fibrillation at 12 months (HR 3.717, 95% CI 1.760-7.850, p=0.001). The enhanced endpoint of pulmonary vein isolation using ATP injection, pacing capture, and supplemental ablation significantly reduced the 12-month recurrence of AF to 9.8% compared with 30.4% in the observation group.
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