Key result
A high comorbidity burden was associated with higher 5-year recurrence of atrial arrhythmia after pulmonary vein isolation compared to a low burden (64.4% vs 53.1%; HR 1.26; 95% CI 1.03-1.53; P=0.01).
Why the study?
It remains unclear whether catheter ablation, particularly pulmonary vein isolation, achieves comparable efficacy to antiarrhythmic drug therapy in multimorbid patients with atrial fibrillation.
Does pulmonary vein isolation (PVI) effectively maintain long-term rhythm control in multimorbid patients with atrial fibrillation?
Cohort
Does pulmonary vein isolation (PVI) effectively maintain long-term rhythm control in multimorbid patients with atrial fibrillation?
Long-term rhythm control with pulmonary vein isolation is significantly less effective in AF patients with a high comorbidity burden, questioning its routine first-line use in this population.
PVI linked to higher long-term recurrence in multimorbid AF; leaves open whether ablation matches drug-based ERC in randomized trials.
BACKGROUND: Early rhythm control (ERC) improves cardiovascular outcomes in patients with atrial fibrillation (AF) and a high comorbidity burden, but this benefit has been demonstrated primarily through antiarrhythmic drug therapy. It remains unclear whether catheter ablation-particularly pulmonary vein isolation (PVI)-achieves comparable efficacy in this high-risk population. OBJECTIVE: We aimed to assess the long-term effectiveness and safety of PVI in multimorbid patients with AF. The primary end point was the recurrence of any atrial arrhythmia after a 90-day blanking period. Secondary end points included procedural safety and mortality. RESULTS: Over a mean follow-up of 2 years (range 6 months to 5 years), recurrence rates were significantly higher in patients with high vs low comorbidity burden at 5 years (Kaplan-Meier event rates: 64.4% vs 53.1%; HR 1.26; 95% CI 1.03-1.53; P = .01). Age ≥75 years was the only independent predictor of recurrence. Safety outcomes and procedural safety were similar across groups. CONCLUSION: Despite the established prognostic benefit of ERC in multimorbid patients, long-term rhythm control with PVI is significantly less effective in this population. These findings question routine first-line use of ablation-based strategies in patients most likely to benefit from rhythm control, highlighting the need for randomized trials comparing pharmacologic and ablative ERC in high-risk AF cohorts.
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Rothe et al. (2025) conducted a cohort in Atrial fibrillation. High comorbidity burden (score ≥4) vs. Low comorbidity burden (score <4) was evaluated on Recurrence of any atrial arrhythmia after a 90-day blanking period (HR 1.26, 95% CI 1.03-1.53, p=0.01). A high comorbidity burden was associated with higher 5-year recurrence of atrial arrhythmia after pulmonary vein isolation compared to a low burden (64.4% vs 53.1%; HR 1.26; 95% CI 1.03-1.53; P=0.01).
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