Key result
Extended ablation did not reduce arrhythmia recurrence compared with limited ablation in patients with pulmonary hypertension and supraventricular arrhythmias (42% vs. 45%; HR 0.97, 95% CI 0.49-2.0).
Why the study?
It was unknown whether extensive bi-atrial substrate ablation is superior to clinical arrhythmia ablation alone for supraventricular arrhythmias in pulmonary hypertension.
Does extensive substrate-based ablation reduce arrhythmia recurrence in patients with pulmonary hypertension and supraventricular arrhythmias compared to clinical arrhythmia ablation alone?
Population
77 patients with combined post- and pre-capillary or isolated pre-capillary PH and supraventricular arrhythmias
Comparison
Clinical arrhythmia plus substrate-based ablation vs clinical arrhythmia ablation only
Design
Three-centre 1:1 randomized parallel-group trial
Follow-up
Median 13 (interquartile range: 12; 19) months
Authors
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Extended ablation adds no benefit over limited ablation here; challenges routine substrate modification in pulmonary hypertension.
RCT (n=77)
1:1
Yes
Does extensive substrate-based ablation reduce arrhythmia recurrence in patients with pulmonary hypertension and supraventricular arrhythmias compared to clinical arrhythmia ablation alone?
Hazard Ratio: 0.97 (95% CI 0.49–2)
Absolute Event Rate: 42% vs 45%
Extensive substrate-based ablation does not significantly reduce arrhythmia recurrence compared to limited clinical arrhythmia ablation in patients with pulmonary hypertension and supraventricular arrhythmias.
Havránek et al. (2023) conducted an RCT in Pulmonary hypertension and supraventricular arrhythmias (n=77). Extended ablation (clinical arrhythmia plus substrate-based ablation) vs. Limited ablation (clinical arrhythmia ablation only) was evaluated on Arrhythmia recurrence >30 s without antiarrhythmic drugs after the 3-month blanking period (HR 0.97, 95% CI 0.49-2.0). Extended ablation did not reduce arrhythmia recurrence compared with limited ablation in patients with pulmonary hypertension and supraventricular arrhythmias (42% vs. 45%; HR 0.97, 95% CI 0.49-2.0).
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