Posterior wall ablation during pulsed field ablation was not independently associated with arrhythmia recurrence compared to pulmonary vein isolation alone (aHR 1.36; 95% CI 0.77–2.39).
Cohort (n=387)
Yes
Does the addition of posterior wall ablation to pulmonary vein isolation reduce arrhythmia recurrence in patients with persistent atrial fibrillation undergoing pulsed field ablation?
Adding posterior wall ablation to pulmonary vein isolation during pulsed field ablation for persistent atrial fibrillation does not reduce arrhythmia recurrence and may increase the late recurrence hazard.
Hazard Ratio: 1.36 (95% CI 0.77–2.39)
Absolute Event Rate: 26.8% vs 19.5%
p-value: p=0.19
Background Posterior wall ablation (PWA) is frequently performed during pulsed field ablation (PFA) of persistent atrial fibrillation (pe-AF), despite unclear evidence. We aim to study the safety and efficacy of PWA, compared to pulmonary vein isolation (PVI) alone, in this population. Methods In this multi-center study, we included all patients with pe-AF who underwent PFA from April to November, 2024. Clinical records were retrospectively reviewed for demographics, procedural details, and clinical outcomes. Results During the study period, 387 patients with pe-AF underwent PFA (mean age 68.7 years, 32.0% female, 80.1% PWA). At a mean (standard error of the mean) follow-up of 12.1 (0.3) months, arrhythmia recurrence was 19.5% for PVI and 26.8% for PVI + PWA (p = 0.19). In multivariable Cox proportional hazards models, PWA was not independently associated with arrhythmia recurrence (adjusted hazard ratio aHR 1.36; 95% confidence interval CI 0.77–2.39) or with pe-AF recurrence requiring additional rhythm control strategies (aHR 1.08; 95% CI 0.57–2.05). Of the recurrences after PWA, 25.3% were with atrial flutter/tachycardia (AFL/AT). In a time-varying Cox analysis, there was evidence of treatment-effect non-proportionality (p = 0.02). PWA was not associated with recurrence 90–190 days post-ablation (aHR 0.78; 95% CI 0.40–1.53), but was associated with higher recurrence hazard thereafter (aHR 3.13; 95% CI 1.10–8.87). Conclusions PWA was not associated with atrial arrhythmia recurrence in patients with pe-AF. More recurrences in the form of AFL/AT, in combination with a late increase in recurrence hazard, may be indicative of a potential for re-entry after PWA. Graphical abstract
Lorente-Ros et al. (Mon,) conducted a cohort in persistent atrial fibrillation (pe-AF) (n=387). Posterior wall ablation (PWA) vs. Pulmonary vein isolation (PVI) alone was evaluated on arrhythmia recurrence (aHR 1.36, 95% CI 0.77-2.39, p=0.19). Posterior wall ablation during pulsed field ablation was not independently associated with arrhythmia recurrence compared to pulmonary vein isolation alone (aHR 1.36; 95% CI 0.77–2.39).