SCVA-guided ablation significantly improved 2-year recurrence-free survival compared to standard anatomical PVI in patients with persistent atrial fibrillation (72.6% vs 56.1%; HR 0.31; 95% CI 0.21-0.67; P=0.003).
Cohort (n=175)
Does slow conduction velocity area-guided ablation reduce the recurrence of atrial fibrillation or new-onset supraventricular tachycardia in patients with persistent atrial fibrillation undergoing initial radiofrequency catheter ablation?
Targeting slow conduction velocity areas in addition to standard pulmonary vein isolation significantly improves recurrence-free survival in patients with persistent atrial fibrillation.
Hazard Ratio: 0.31 (95% CI 0.21–0.67)
Absolute Event Rate: 72.6% vs 56.1%
p-value: p=0.003
Background Pulmonary vein isolation (PVI) is a well-established treatment for atrial fibrillation (AF). However, in patients with persistent AF, PVI alone is often insufficient, and no adjunctive strategy with proven efficacy beyond PVI has been established. Recently, increasing attention has been directed toward local atrial conduction velocity (CV). Slow conduction velocity areas (SCVAs) have been regarded as potential arrhythmogenic substrates, and ablation strategies targeting SCVAs are under investigation. This study evaluated the efficacy of SCVA-guided ablation in patients with persistent AF. Methods We enrolled 175 patients with persistent AF who underwent initial radiofrequency catheter ablation (RFCA). SCVAs were defined as contiguous atrial regions with a local CV < 0.7 m/s and a surface area ≥ 2.0 cm². SCVA-guided ablation was performed in 84 patients, whereas standard anatomical PVI was performed in 91 patients. The primary outcome was recurrence of AF or occurrence of new-onset supraventricular tachycardia during a two-year follow-up period. Results During follow-up, clinical recurrence occurred in 63 patients (36.0%). Patients in the SCVA-guided ablation group demonstrated a significantly higher recurrence-free survival rate compared with those in the standard PVI group (72.6% vs. 56.1%; log-rank P = 0.01). Multivariate analysis identified SCVA-guided ablation (hazard ratio HR 0.31, 95% confidence interval CI 0.21–0.67, P = 0.003) and left atrial (LA) volume index (HR 1.03, 95% CI 1.01–1.06, P = 0.001) as independent predictors of AF recurrence. Conclusion SCVAs represent important arrhythmogenic substrates. Incorporating these regions into PVI significantly reduced AF recurrence compared with standard anatomical PVI. Graphical Abstract
Okubo et al. (Mon,) conducted a cohort in Persistent atrial fibrillation (n=175). Slow conduction velocity area (SCVA)-guided ablation vs. Standard anatomical pulmonary vein isolation (PVI) was evaluated on Recurrence of AF or occurrence of new-onset supraventricular tachycardia (reported as recurrence-free survival) (HR 0.31, 95% CI 0.21-0.67, p=0.003). SCVA-guided ablation significantly improved 2-year recurrence-free survival compared to standard anatomical PVI in patients with persistent atrial fibrillation (72.6% vs 56.1%; HR 0.31; 95% CI 0.21-0.67; P=0.003).