Key result
Adding posterior wall box isolation to CPVI reduced AF recurrence in patients with smaller epicardial fat volumes (HR 0.74; 95% CI 0.56-0.99), but provided no benefit in those with larger volumes.
Why the study?
Greater epicardial adipose tissue is related to higher recurrences after AFCA, but the effects of additional posterior wall box isolation to CPVI according to EAT volume were unclear.
Does additional posterior wall box isolation (POBI) reduce clinical recurrence of atrial fibrillation in patients with persistent atrial fibrillation undergoing catheter ablation?
Cohort (n=1,187)
Does additional posterior wall box isolation (POBI) reduce clinical recurrence of atrial fibrillation in patients with persistent atrial fibrillation undergoing catheter ablation?
Hazard Ratio: 0.74 (95% CI 0.56–0.99)
p-value: p=0.002 for interaction
Additional posterior wall box isolation during catheter ablation reduces atrial fibrillation recurrence in patients with persistent AF and smaller epicardial adipose tissue volumes, but offers no benefit in those with larger volumes.
Background Greater epicardial adipose tissue (EAT) is related to higher recurrences after atrial fibrillation catheter ablation (AFCA). We investigated the effects of posterior wall box isolation (POBI) in conjunction with circumferential pulmonary vein isolation (CPVI) on rhythm outcomes according to varying EAT volumes among patients with persistent atrial fibrillation (PeAF). Materials and methods We included 1,187 patients with PeAF undergoing a de novo AFCA including those receiving CPVI alone ( n = 687) and those receiving additional POBI ( n = 500). The rhythm outcomes at 2 years post-AFCA were compared in subgroups stratified by the EAT volume using propensity overlap weighting. Results A reduced EAT volume was linearly associated with more favorable rhythm outcomes for additional POBI than for CPVI alone (P for interaction = 0.002). Among the patients with smaller EAT volumes (≤116.23 mL, the median value, n = 594), additional POBI was associated with a reduced AF recurrence risk as compared to CPVI only [weighted HR (hazard ratio) 0.74, 95% CI (confidence interval) 0.56–0.99]. In contrast, among the remaining 593 patients with greater EAT volumes (>116.23 mL), No difference was observed in the recurrence risk between the additional POBI and CPVI alone groups (weighted HR 1.13, 95% CI 0.84–1.52). Among 205 patients with repeat ablations, the POBI reconnection rate was more frequent in the large EAT group (77.4%) than in the small EAT group (56.7%, P = 0.034). Conclusion While PeAF patients with a smaller EAT volume averted AF recurrence by additional POBI after CPVI, no benefit of the POBI was observed in those with a greater EAT volume.
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Kim et al. (2022) conducted a cohort in Persistent atrial fibrillation (n=1,187). Posterior wall box isolation (POBI) in addition to circumferential pulmonary vein isolation (CPVI) vs. CPVI alone was evaluated on Atrial fibrillation recurrence at 2 years post-ablation (HR 0.74, 95% CI 0.56-0.99, p=0.002 for interaction). Adding posterior wall box isolation to CPVI reduced AF recurrence in patients with smaller epicardial fat volumes (HR 0.74; 95% CI 0.56-0.99), but provided no benefit in those with larger volumes.
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