Key result
EGF-guided ablation links to ~59% fewer AF recurrences at 12 months versus PVI alone.
Why the study?
Catheter ablation for persistent AF has suboptimal success rates, and existing mapping technologies cannot reliably distinguish sources in this population.
Does EGF-guided catheter ablation reduce AF recurrence in patients with persistent atrial fibrillation compared to empiric ablation strategies?
Cohort (n=70)
Does EGF-guided catheter ablation reduce AF recurrence in patients with persistent atrial fibrillation compared to empiric ablation strategies?
EGF-guided catheter ablation significantly reduces AF recurrence at 12 months compared to PVI alone or PVI with empiric lines in patients with persistent atrial fibrillation.
Answers are grounded in this paper and cite their sources.
EGF-guided ablation was associated with fewer recurrences in persistent AF; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Catheter ablation (CA) remains challenging due to suboptimal success rates in persistent atrial fibrillation (AF). Existing mapping technologies cannot reliably distinguish sources in this patient population. Recently, the novel electrographic flow (EGF) mapping system was developed using a modified Horn-Schunk optical flow algorithm to detect and quantify patterns of electrical wavefront propagation in the atria. OBJECTIVES: To test the hypothesis that targeted source ablation based on EGF mapping is superior to empiric AF ablation. METHODS: We included all consecutive patients undergoing EGF guided ablation for persistent AF. All patients underwent pulmonary vein isolation (PVI) and were treated with the same EAM system (CARTO). The outcome of PVI+EGF guided CA was compared with data of PVI-only procedures (PVI-only group) and PVI plus additional empiric adjunctive linear and substrate ablations (PVI+LINES group). 12-months outcome as freedom from AF and atrial tachycardia/flutter (AT/AFL), procedural safety and efficiency characterized by procedure duration, fluoroscopy use, radiofrequency applications and duration, were analyzed. Both intention-to-treat and per protocol analysis were conducted. RESULTS: A total number of 70 patients (39 in PVI+EGF, 16 in PVI-only and 15 patients in PVI+LINES group) were enrolled. Intention-to-treat analysis showed fewer AF recurrences in PVI+EGF as compared with the PVI-only or PVI+LINES groups at 12 months (25.6% vs. 62.5% vs. 53.3%, p = .02). There were no differences in AT/AFL recurrence (17.9% vs. 37.5% vs. 20.0%, p = .37). Procedure times were longer in PVI+EGF group (p < .01), and there were no differences in fluoroscopy use (p = .67). CONCLUSION: Our data suggest that patients treated with EGF-guided CA developed fewer AF recurrences. Although the procedure times are longer, it seems to be safe and offers a more targeted, patient-specific ablation strategy beyond PVI than adjunctive empiric lines and substrate ablation in this complex group of patients.
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Gagyi et al. (2023) conducted a cohort in Persistent atrial fibrillation (n=70). EGF-guided catheter ablation (PVI+EGF) vs. PVI-only and PVI plus empiric adjunctive linear and substrate ablations (PVI+LINES) was evaluated on AF recurrences at 12 months (p=0.02). EGF-guided catheter ablation resulted in fewer AF recurrences at 12 months compared to PVI-only or PVI plus empiric lines.
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